RTRMF – COLLEGE OF NURSING
LEVEL II
THE NURSING ROLE IN THE
REPRODUCTIVE AND SEXUAL
HEALTH
You are a nurse who works at a reproductive clinic. A couple comes to you for help on how they
will be able to start a family. They ask you questions on options they could use in order to monitor
their fertilization as they have been trying for years to have a child.
As a nurse, do you think you are ready to be a health advocate for patients who are dealing with
reproductive problems?
ANSWER: This is one of the most disregarded portions of the reproductive health, especially in
our country. It is very uncommon for us to address reproductive problems with options
of in vitro fertilization and even adoption, as some people are not open to trying to
choose this option for them to be able to start a family. This is something very
important for us to deal with, as health care providers. We should also be able to
address these situations because these are fairly common. Individuals who have
problems with reproductive and childbearing/childrearing situations, it is not very easy
to deal with. Quite honestly, it is on the end of the health care provider to ensure their
needs will also be addressed.
I. REPRODUCTIVE DEVELOPMENT
- Reproductive development and change begin at the moment of conception and
continue throughout life.
A. Intrauterine Development
- The sex of an individual is determined by chromosome information supplied by
the particular ovum and sperm that joined to create new life.
- At approximately week 5 of intrauterine life, primitive gonadal tissue is already
formed.
- By week 7 or 8, in chromosomal males, this early gonadal tissue differentiates
into primitive testes and begins formation of testosterone formed.
Page 1 of 21
NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LECTURER: Tatyana Lauren Poblete - Ajero
Their union would help us with the identification of the human cell.
- If testosterone is not present by week 10, the gonadal tissue differentiates into
ovaries, and the paramesonephric duct develops into female reproductive
organs.
Expected for the male products to be formed earlier than the female organs.
- All of the oocytes (cells that will develop into eggs throughout the woman’s
mature years) are already formed into ovaries at this stage (Week 10).
- WEEK 12: In males, under the influence of testosterone, penile tissue elongates
and the urogenital fold on the ventral surface of the penis closes to form the
urethra; in females, with no testosterone present, the urogenital fold remains
open to form the labia minora; what would form as scrotal tissues in the male
becomes the labia majora of the female.
B. Pubertal Development
- Secondary sex changes begin.
- These changes are stimulated when the hypothalamus synthesizes and
releases gonadotropin-releasing hormone (GNRH), which in turn triggers the
anterior pituitary to begin the release of follicle-stimulating hormones (FSH) and
luteinizing hormone (LH).
 FSH-LH
- initiate the production of androgen and estrogen, which in turn initiate
secondary sex characteristics, the visible signs of maturity.
If ever there would be any discrepancies or deficiencies in the
production of FSH/LH, then this would certainly develop problems
and would make the individual not develop the secondary
characteristics.
 Follicle Stimulating Hormone (FSH)
© ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL
RTRMF – COLLEGE OF NURSING NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LEVEL II LECTURER: Tatyana Lauren Poblete - Ajero

- is a gonadotropin, a glycoprotein polypeptide hormone. end to growth because it closes the epiphyses of the long bones.
- is synthesized and secreted by the gonadotropic cells of the anterior The beginning of breast development (by the estrogen) is termed
pituitary gland, and regulates the development, growth, pubertal THELARCHE.
maturation, and reproductive processes of the body.
- FSH and luteinizing hormone (LH) work together in the development  Secondary Sex Characteristics
of the reproductive system.
i. FEMALE
 Luteinizing Hormone 1. Growth spurt
- is made by your pituitary gland, a small gland located underneath the Comparing males from females, the growth spurt of
brain. females is faster to develop at an early age than males.
- plays an important role in sexual development and functioning. 2. Increase in the transverse diameter of the pelvis
- In women, LH helps control the menstrual cycle. It also triggers the Curved shape of the body
release of an egg from the ovary. 3. Breast development
4. Growth of pubic hair
 Androgen 5. Onset of menstruation
- The hormones responsible for muscular development, physical 6. Growth of axillary hair
growth, and the increase in sebaceous gland secretions that causes 7. Vaginal secretion
typical acne in both boys and girls. In preparation for the proper functioning of the
- In males, androgenic hormones are produced by the adrenal cortex reproductive system
and the testes, in females, by the adrenal cortex and the ovaries.
- Low in males until puberty (12-14) – development of the testes ii. MALE
scrotum, penis prostate, and the seminal vesicles; the appearance of
male pubic, axillary, and facial hair; laryngeal enlargement and its In males, production of spermatozoa does not begin in intrauterine
accompanying voice change; maturation of spermatozoa; and life as does the production of ova, nor are spermatozoa produced
closure of growth in long bone. in a cyclic pattern as are ova; rather, they are produced in
Somehow, the androgen hormone develops further as males grow continuous process.
up which will then help us identify a more profound expression of the
secondary characteristics in males. 1. Increase in weight
- ADRENARCHE – development of pubic and axillary hair because of 2. Growth of testes
androgen stimulation 3. Growth of face, axillary, and pubic hair
4. Voice changes
5. Penile growth
 Estrogen
6. Increase in height
- As puberty hits, ovarian follicles in females begin to excrete a high
7. Spermatogenesis (production of sperm)
level of the hormone estrogen.
Point where males experience wet dreams, the transition
- Three compounds (estrone [E1], estradiol [E2], and estriol [E3]). It
of a younger male towards adolescence
is a single substance in terms of action.
- The increase in estrogen levels in the female at puberty influences
the development of the uterus, fallopian tubes, and vagina; typical
female fat distribution and hair patterns; breast development; and the

Page 2 of 21 © ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL

RTRMF – COLLEGE OF NURSING
LEVEL II
II. THE MALE REPRODUCTIVE SYSTEM
A. Male External Structures
 Scrotum
- Rugate, skin-covered, muscular pouch suspended from the
perineum.
- Its functions to support the testes and to help regulate the
temperature of the sperm.
- In very cold weather, the scrotal muscle contracts to bring the testes
closer to the body; in very hot weather, or in the presence of fever,
the muscle relaxes allowing the testes to fall away from the body.
This response is to preserve the sperm produced or stored in the
scrotal sacs.
 Testes
- Two ovoid glands, 2-3 cm wide, that lie in the scrotum.
- Each testis is encased by a protective white fibrous capsule and is
composed of several lobules, with each lobule containing interstitial
cells (Leydig’s cell) and the seminiferous tubule.
- Seminiferous tubules produce spermatozoa.
- Leydig’s cell are responsible for the production of testosterone.
Page 3 of 21
NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LECTURER: Tatyana Lauren Poblete - Ajero
i. DEVELOPMENT OF THE TESTES
• Testes in a fetus first form in the pelvic cavity. They descend,
late in intrauterine life (about the 34th to 38th week), into the
scrotal sac.
• Many male preterm infants are born with undescended
testes. These infants needed to be monitored closely to see
that the testes do descend when the infant reaches what
would have been the 34th to 38th week of gestational age,
because testicular descent does not occur as readily in
extrauterine life as it does in utero.
There is this condition called “undescended testis”
• Testes that remain in the pelvic cavity may not produce
viable sperm and area associated with a 4 to 7 times higher
incidence of testicular cancer.
• Gonadotropin-releasing hormone causes the pituitary gland
in the brain to make and secrete the hormones: luteinizing
hormone (LH) and follicle-stimulating hormone (FSH). In
men, these hormones cause the testicle to make
testosterone. In women, they cause the ovaries to make
estrogen and progesterone.
• In most males, one testis is slightly larger than the other and
is suspended slightly lower in the scrotum than the other
(usually the left one, less trauma with movement and
activity).
• Beginning in early adolescence, boys need to learn testicular
self-examination so that they can detect tenderness or any
abnormal growth in the testes.
• Normal testes feel firm, smooth, and egg shaped. The
epididymis (the tube that carries sperm away from the
testes) can be palpated as a firm swelling on the superior
aspect of the testes.
• Caution boys not to make mistake this structure for an
abnormal growth.
 Penis
- composed of three cylindrical masses of erectile tissue in the penis
shaft: two termed the corpus cavernosa, and a third termed the
corpus spongiosum.
© ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL
RTRMF – COLLEGE OF NURSING
LEVEL II
- Outlet for both the urinary and reproductive tract in men.
- The ISCHIOCAVERNOSUS MUSCLE at the base of the penis then
contracts, trapping both venous and arterial blood in the three
sections of erectile tissue and leading to distension and erection of
the penis.
- The penile artery, a branch of the pudendal artery, provides the
blood supply for the penis, especially during erection.
- Penile erection is stimulated by parasympathetic nerve
innervations.
- At the distal end of the organ is a bulging, sensitive ridge of tissue,
the GLANS.
- A retractable casing of skin, the PREPUCE, protects the nerve-
sensitive glans at birth.
B. Male Internal Structures
 Epididymis
- Tightly coiled tube which is responsible for conducting sperm from
the tubule to the vas deferens, the next step in the passage to the
outside.
- It is actually over 20 ft long.
- It takes at least 12 to 20 days for them to travel the length of the
epididymis and a total of 64 days for them to reach maturity.
 Vans deferens (Ductus deferens)
- It carries sperm from the epididymis through the inguinal canal into
the abdominal cavity, where it ends at the seminal vesicles and the
ejaculatory ducts.
- Sperm matures as they pass through the vas deferens. They are still
not mobile at this point, however, probably because of the fairly
acidic medium of the semen produced at this level.
- Vasectomy (severing of the vas deferens to prevent passage of
sperm) is a popular means of male birth control.
 Seminal vesicles
- The seminal vesicles are two convoluted pouches that lie along the
lower portion of the posterior surface of the bladder and empty into
the urethra by way of the ejaculatory ducts.
Page 4 of 21
NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LECTURER: Tatyana Lauren Poblete - Ajero
- These glands secrete a viscous alkaline liquid that has a higher
sugar, protein, and prostaglandin content.
 Ejaculatory ducts
- The two ejaculatory ducts pass through the prostate gland and join
the seminal vesicles to the urethra.
 Prostate gland
- A chest-nut sized gland that lies just below the bladder. The urethra
passes through the center of it, like the hole in a donut.
- The prostate gland secretes a thin alkaline fluid.
- The alkaline fluid further protects sperm from being immobilized by
the naturally low pH level of the urethra.
 Bulbourethral glands
- Two bulbourethral or Cowper’s glands lie beside the prostate gland
and empty via short ducts into the urethra.
- They secrete an alkaline fluid that helps counteract the acid
secretions of the urethra and ensure the safe passage of
spermatozoa.
 Urethra
- Hollow tube leading from the base of the bladder, which, after
passing through the prostate gland, continues to the outside through
the shaft and glans of the penis.
- It is approximately 8 inches (18 to 20 cm) long. Like other urinary
tract structures, it is lined with mucous membrane.
When we compare male and female reproductive organs, females are most likely to have
urinary tract infections compared to males as the urethra is longer in males compared to
females.
III. THE FEMALE REPRODUCTIVE SYSTEM
© ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL
RTRMF – COLLEGE OF NURSING
LEVEL II
A. Female External Structures
 Mons Veneris
- Pad of adipose tissue located over the symphysis pubis, the pubic
bone joint.
- It is covered by a triangle of course, curly hairs.
- The purpose of the mons veneris is to protect the junction of the
pubic bone from trauma.
 Labia Minora
- Two inner hairless folds of connective tissue, the labia minora.
- Before menarche, these folds are fairly small; by childbearing age
they are firm and full; after menopause, they atrophy and again
become much smaller.
- The area is abundant with sebaceous glands, so localized
sebaceous cysts may occur here.
 Labia Majora
- Two folds of adipose tissue covered by loose connective tissue and
epithelium that are positioned lateral to the labia minora. (external)
- Covered by pubic hair, the labia majora serve as protection for the
external genitalia and the distal urethra and vagina.
- They are fused anteriorly but separated superiorly.
- The trauma to the area, such as occurs from childbirth or rape, can
lead to extensive edema formation.
In the concept of childbearing, by the time the mother will be crowning, the orifice of the
vagina will expand big enough for the head of the baby pass through. Especially if the mother
would try to push at the time the mother is not yet time meant to push.
Page 5 of 21
NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LECTURER: Tatyana Lauren Poblete - Ajero
For a successful natural childbirth, there should be a point where the cervix will be opened at
10cm, the head should be stationed at level 0 and the head of the baby start to move towards
the vaginal opening where it will start to engage and at the same time, magpupush na gihap
hiya in accordance to how the mother would bear down.
If the mother will start bearing down if not meant to do so (dilation of below 10cm), it will
cause trauma to the pudendal area and if that happens, the body will respond and turn
edematous.
 Vestibule
- is the flattened, smooth surface inside the labia. The openings to the
bladder (the urethra) and the uterus (the vagina) both arise from the
vestibule.
 Clitoris
- is a small (approximately 1 to 2 cm), rounded organ of erectile tissue
at the forward junction of the labia minora. It is covered by a fold of
skin, the prepuce. The clitoris is sensitive to touch and temperature
and is the center of sexual arousal and orgasm in a woman.
----------------------------------------------------------------------------------------------------------------------------
1. How would you know if you were able to successfully insert the tube into the urethra and
not into the vagina?
- We can determine if the tube is inserted into the urethra and not into the vagina when there
is presence of urine output upon inserting the tube into the bladder.
2. If you have mistakenly inserted the catheter into the vaginal orifice, what then should you
do?
- If I mistakenly inserted the catheter into the vaginal orifice, I would not remove it first
because it may be used as a landmark. I will then start inserting a new catheter into the
urethra. (T.B.)
----------------------------------------------------------------------------------------------------------------------------
 Two Skene’s Glands (paraurethral glands)
- are located just lateral to the urinary meatus, one on each side. Their
ducts open into the urethra.
 Bartholin’s Glands (vulvovaginal glands)
© ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL
RTRMF – COLLEGE OF NURSING
LEVEL II
- are located just lateral to the vaginal opening on both sides. Their
ducts open into the distal vagina.
 Secretions from these two glands help to lubricate the external genitalia during
coitus.
 Fourchette
- is the ridge of tissue formed by the posterior joining of the two labia
minora and the labia majora.
- This is the structure that is sometimes cut (episiotomy) during
childbirth to enlarge the vaginal opening.
Fourchette is cut in instances when the baby’s head is too big for a normal delivery. It will be
supported with gauze to prevent further bleeding and simultaneously done when the mother
is bearing down to lessen the pain (pero masakit la gihap kuno)
 Perineal muscle or the Perineal body
- is a muscular area, it is easily stretched during childbirth to allow for
enlargement of the vagina and passage of the fetal head.
 Hymen
- is a tough but elastic semicircle of tissue that covers the opening to
the vagina in childhood
- is often torn during the time of first sexual intercourse.
- Use of tampons and active sports participation, many girls who have
not had sexual relations do not have intact hymens at the time of
their first pelvic examination.
i. VULVAR BLOOD SUPPLY
• The blood supply of the external genitalia is mainly from the
pudendal artery and a portion of the inferior rectus artery.
Venous return is through the pudendal vein.
• Pressure on this vein by the fetal head can cause extensive
back-pressure and development of varicosities (distended
veins) in the labia majora.
• This ready blood supply also contributes to the rapid healing of
any tears in the area after childbirth.
ii. VULVAR NERVE SUPPLY
Page 6 of 21
NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LECTURER: Tatyana Lauren Poblete - Ajero
• The anterior portion of the vulva derives its nerve supply from
the ilioinguinal and genitofemoral nerves (L1 level).
• The posterior portions of the vulva and vagina are supplied by
the pudendal nerve (S3 level). Such a rich nerve supply makes
the area extremely sensitive to touch, pressure, pain, and
temperature.
• Anesthesia for childbirth may be administered locally to block
the pudendal nerve, further eliminating pain sensation at the
perineum during birth.
B. Female Internal Structures
 Ovaries
- Are approximately 4 cm long by 2 cm in diameter and approximately
1.5 thick, or the size and shape of almonds.
- Grayish white and paper pitted, or with minute indentations on the
surface.
- An unruptured, glistening, clear, fluid-filled graafian follicle (an
ovum about to be discharged) or a miniature yellow corpus luteum
(the structure left behind after the ovum has been discharged) often
can be observed of an ovary.
- The function of the two ovaries (the female gonads) is to produce,
mature, and discharge ova (the egg cell). In the process, the ovaries
produce estrogen and progesterone and initiate and regulate
menstrual cycles.
i. IF OVARIES ARE REMOVED
© ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL
RTRMF – COLLEGE OF NURSING NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LEVEL II LECTURER: Tatyana Lauren Poblete - Ajero

• BEFORE PUBERTY: the resulting absence of estrogen • Between 5 and 7 million ova form in utero. The majority
prevents breasts from maturing at puberty; in addition, pubic never develops beyond the primitive stage and actually
hair distribution assumes a more male pattern than normal. atrophy, so that by birth, only 2 million are present. By age 7
• AFTER PUBERTY: the uterus, breasts, and ovaries all years, only approximately 500,000 are present in each
undergo atrophy or a reduction in size because of a lack of ovary; by 22 years, there are approximately 300,000; and by
estrogen. Ovarian function, therefore, is necessary for menopause, none are left.
maturation and maintenance of secondary sex
characteristics in females.

ii. ESTROGEN USE

• Estrogen used to be prescribed for women at menopause to  Fallopian Tube
help prevent osteoporosis and cardiovascular disease.
• Long-term estrogen supplementation may contribute to
breast cancer and cerebrovascular accidents, so it is no
longer routinely recommended.
• Since they (ovaries) are suspended in position rather than
being firmly fixed in place, an abnormal tumor or cyst
growing on them can enlarge to a size easily twice that of
the organ before pressure on surrounding organs or the
ovarian blood supply leads to symptoms of compression.
Ovaries are free moving which is more likely to develop
cysts or overgrowth, “new growth” for the ovary.
- Arise from each upper corner of the uterine body and extended
outwards and backward until each open at its distal end, next to an
iii. DIVISION OF REPRODUCTIVE CELLS (GAMETES)
ovary.
• Although these cells have the unique ability to produce a
- Approximately 10 cm long in a mature woman.
new individual, they basically contain the usual components
Example: The fertilized egg will pass through the fallopian tube and would go to the uterus for
of cells: a cell membrane, an area of clear cytoplasm, and a
implantation, we have what we call “ectopic pregnancy”.
nucleus containing chromosomes.
Ectopic Pregnancy is where the fertilized egg is implanted not in the uterus but in the fallopian
• Reproductive cells (both ova and spermatozoa) have only
tube (usually in the ampulla)
half the usual number of chromosomes, so that, when they
- Their function is to convey the ovum from the ovaries to the uterus
combine (fertilization), the new individual formed from them
and to provide a place for fertilization of the ovum by sperm.
will have the normal number of 46 chromosomes.
• If both the ova and the spermatozoa carried full complement
1. Fimbriae
of chromosomes, a new individual formed from them would
- Finger-like, ciliated projections which capture the ovum
have twice the normal number.
from the surface of the ovary.
2. Infundibulum
iv. MATURATION OF OOCYTES

Page 7 of 21 © ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL

RTRMF – COLLEGE OF NURSING NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LEVEL II LECTURER: Tatyana Lauren Poblete - Ajero

- Funnel-shaped opening near the ovary to which fimbriae 2. Isthmus

are attached. - is a short segment between the body and the cervix, In the
3. Ampulla nonpregnant uterus, it is only 1-2 mm in length.
- Widest section of the uterine tubes. Fertilization usually - During pregnancy, this portion also enlarges greatly to aid in
occurs here. accommodating the growing fetus. It is the portion of the
4. Isthmus uterus that is most commonly cut when a fetus is born by a
- Narrow section of the uterine tubes connecting the cesarean birth.
ampulla to the uterine cavity. 3. Cervix
 Uterus - The lowest portion of the uterus. It represents approximately
- A hollow, muscular, pear-shaped organ located in the lower pelvis, 2 to 5 cm long.
posterior to the bladder and anterior to the rectum. - Approximately half of it lies above the vagina and half
- During childhood, it is approximately the size of an olive, and its extends into the vagina. Its central cavity is termed the
proportion are reversed from what they are later (i.e., the cervix is cervical canal.
the largest portion - The opening of the canal at the junction of the cervix and
- 8 years of age is an increase in the size of the uterus begins. An isthmus is the internal cervical os, the distal opening to the
adolescent is closer to 17 years old before the uterus reaches its vagina is the external cervical os.
adult size.
i. UTERINE AND CERVICAL COATS

1. Endometrium Layer
- is the one that is important for menstrual function.
The endometrial lining sloughs off during menstruation.
- It is formed by two layers of cells:
• Basal Layer – the layer closest to the uterine wall,
remains stable, and uninfluenced by hormones.
• Inner Glandular Layer – is greatly influenced by both
estrogen and progesterone. It grows and becomes so
thick and responsive each month under the influence of
- Consists of three divisions: the body or corpus, isthmus, and the
estrogen and progesterone that it is capable of
cervix.
supporting a pregnancy.
- If pregnancy does not occur, this is the layer that is shed as
1. Fundus
the menstrual flow.
- The portion of the uterus between the points of attachments
of the fallopian tubes.
2. Endocervix
- is also the portion that can be palpated abdominally to
- Continuous with the endometrium, is also affected by
determine the amount of uterine growth occurring during
hormones, but changes are manifested in a more subtle way.
pregnancy (fundic height), to measure the force of uterine
- The cells of the cervical lining secrete mucus to provide a
contractions during labor, and to assess that the uterus is
lubricated surface so that spermatozoa can readily pass
returning to its nonpregnant state after childbirth.

Page 8 of 21 © ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL

RTRMF – COLLEGE OF NURSING
LEVEL II
through the cervix; the efficiency of this lubrication increases or
wanes depending on hormone stimulation.
3. Myometrium
- is composed of three interwoven layers of smooth muscles, the
fibers of which are arranged in longitudinal, transverse, and
oblique directions.
- This network offers extreme strength to the organ.
- The myometrium serves the important function of constricting
the tubal junctions and preventing regurgitation of menstrual
blood into the tubes.
- It also holds the internal cervical os closed during pregnancy to
prevent preterm birth.
- Myomas, or benign fibroid (leiomyoma), arise from the
myometrium.
4. Perimetrium
- The outermost layer off the uterus, serves the purpose of
adding strength and support to the structure.
ii. UTERINE BLOOD SUPPLY
• The large descending abdominal aorta divides to form two iliac
arteries; main divisions of the iliac arteries are the hypogastric
arteries.
• The uterine blood supply is not far removed from the aorta, it is
copious and adequate to supply the growing needs of a fetus. As an
additional safeguard, after supplying the ovary with blood, the
ovarian artery (a direct subdivision of the aorta) joins the uterine
artery as a fail-safe system to ensure that the uterus will have an
adequate blood supply.
• The blood vessels that supply the cells and lining of the uterus are
tortuous against the sides of the uterine body in nonpregnant
women.
• This close anatomic relationship of the ureters and the blood supply
for the uterus has implications in procedures such as tubal ligation,
cesarean birth, and hysterectomy (removal of the uterus), because
the ureter may be injured by a clamp if bleeding is controlled by
clamping of the uterine or ovarian vessels.
During cesarian birth, aside from emptying the bladder, the patient
is placed in a catheter in order for the OB to monitor the urine
Page 9 of 21
NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LECTURER: Tatyana Lauren Poblete - Ajero
output if there would be any appearance of blood that could indicate
that they could have accidentally injured the ureters.
iii. UTERINE NERVE SUPPLY
• Uterus is by both efferent (motor) and afferent (sensory) nerves.
• The efferent nerves arise from the T5 through T10 spinal ganglia.
• The afferent nerves join the hypogastric plexus and enter the spinal
column at T11 and T12.
• The fact that sensory innervation from the uterus registers lower in
the spinal column that does motor control has implications in
controlling pain in labor.
iv. UTERINE SUPPORTS
• Because it is not fixed, the uterus is free to enlarge without
discomfort during pregnancy.
• If its ligaments become overstretched during pregnancy, they may
not support the bladder well afterward, and the bladder can then
herniate into anterior vagina (a cystocele).
• If the rectum pouches into the vaginal wall (a rectocele).
v. UTERINE DEVIATIONS
• Several uterine deviations (shape and position) may interfere with
fertility or pregnancy. In the fetus, the uterus first forms with a
septum or a fibrous division, longitudinally separating into two
portions.
• As the fetus matures, this septum dissolves, so that typically at birth
no remnant of the division remains.
• Still other women have oddly shaped “horns” at the junction of the
fallopian tubes, termed a bicornuate uterus.
vi. POSITIONAL DEVIATIONS OF THE UTERUS COMMONLY SEEN
1. Anteversion
- a condition in which the entire uterus is tipped forward
2. Retroversion
- a condition in which the entire uterus is tipped backward
© ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL
RTRMF – COLLEGE OF NURSING
LEVEL II
3. Anteflexion
- a condition in which the body of the uterus is bent sharply
forward at the junction with the cervix
4. Retroflexion
- a condition in which the body of the uterus is bent sharply
back just above the cervix’
 Minor variations of these positions do not cause reproductive problems. Extreme
abnormal flexion or version may interfere with fertility because they can clock the
deposition of migration of sperm.
 Vagina
- A hollow, musculomembranous canal located posterior to the bladder
and anterior to the rectum.
- A circular muscle, the BULBOCAVERNOSUS, at the external opening
of the vagina acts as a voluntary sphincter. Relaxing and tensing this
external vaginal sphincter muscle a set number of times each day
makes it more supple for birth and helps maintain tone after birth
(Kegel’s exercise).
Kegel’s exercise – mothers are encouraged to do this to help maintain
the tone of the vaginal muscles to strengthen the are during childbirth.
- The blood supply to the vagina is furnished by the vaginal artery, a
branch of the internal iliac artery. Vaginal tears at childbirth tend to
bleed profusely because of this rich blood supply. The same rich blood
supply is the reason that any vaginal trauma at birth heals rapidly.
- The vagina is not an extremely sensitive organ, however. Sexual
excitement, often attributed to vaginal stimulation, is influenced mainly
by clitoral stimulation.
 Breasts
- Form from the ectodermic tissue early in utero.
- They then remain in a halted stage of development until a rise in
estrogen at puberty produces a marked increase in their size.
- The size increase occurs mainly because of an increase of connective
tissue plus deposition of fat.
- The glandular tissue of the breasts necessary for successful
breastfeeding, remains undeveloped until a first pregnancy begins.
- Boys may notice a temporary increase in breast size at puberty, termed
GYNECOMASTIA (10-11 years old).
Page 10 of 21
NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LECTURER: Tatyana Lauren Poblete - Ajero
- Breast self-examinations are not as effective in detecting early breast
lesions as once believed and so are no longer routinely recommended.
- When palpating for breast health this way, always include the axillary
region in the examination, or some breast tissue can be missed.
- Milk glands of the breasts are divided by connective tissue partitions
into approximately 20 lobes. All of the glands in each lobe produce milk
by acinar cells and deliver it to the nipple via lactiferous ducts.
 Nipples
- A nipple is composed of smooth muscle that is capable of erection on
manual or sucking stimulation.
- On stimulation, it transmits sensations to the posterior pituitary gland
to release oxytocin.
- Oxytocin acts to constrict milk gland cells and push milk forward the
ducts that lead to the nipple.
- The blood supply to the breasts is profuse because it is supplied by
thoracic branches of the axillary, internal mammary, and intercostal
arteries. This effective blood supply is important in bringing nutrients to
the milk glands and makes possible a plentiful supply of milk for
breastfeeding.
Oxytocin also helps stimulate the mother’s contractions through
stimulating the nipples.
IV. MENSTRUATION
- is episodic uterine bleeding in response to cyclic hormonal changes.
- The purpose of a menstrual cycle is to bring an ovum to maturity and renew a
uterine tissue bed that will be responsible for the ova’s growth should be
fertilized.
- It is the process that allows for conception and implantation of a new life.
- It is good to include health teaching information on menstruation to both school
age children and their children and their parents as early as 4 th grade as part of
routine care.
i. PHYSIOLOGY OF MENSTRUATION
• The length of menstrual cycles differs from woman to woman, but the
average length is 28 days, of one menstrual flow to the beginning of the next.
• It is not unusual for cycles to be as short as 23 days or as long as 35 days.
• The length of the average menstrual flow (termed menses) is 4 to 6 days,
although women may have periods as short as 2 days or as long as 7 days.
© ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL
RTRMF – COLLEGE OF NURSING NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LEVEL II LECTURER: Tatyana Lauren Poblete - Ajero

- Every month during the fertile period of a woman’s life (from the menarche to
ii. FOUR BODY STRUCTURES INVOLVED the menopause), one of the ovary’s primordial follicles is activated by FSH to
1. The hypothalamus begin to grow and mature.
2. The pituitary gland - As it grows, its cells produce a clear fluid (follicle fluid) that contains a high
3. The ovaries degree of estrogen (mainly estradiol) and some progesterone.
4. The uterus - As the follicle reaches its maximum size, it is propelled toward the surface of
the ovary. At full maturity, it is visible on the surface of the ovary as a clear
water blister approximately 0.25 to 0.5 inches across.
- At this stage of maturation, the small ovum (barely visible to the naked eye,
approximately the size of a printed period), with its surrounding follicle
membrane and fluid, is termed graafian follicle.
- By the day 14 before the end of a menstrual cycle (the midpoint of a typical
28-day cycle), the ovum has divided by mitotic division into two separate
bodies: a primary oocyte, which contains the bulk of the cytoplasm, and a
secondary oocyte, which contains so little cytoplasm that is not functional.
- The structure also has accomplished its meiotic division, reducing its number
of chromosomes to the haploid (having only one member of a pair) number
of 23.
A. Hypothalamus
- Upsurge of LH from the pituitary, prostaglandins are released and the
- The hypothalamus releases the GnRH or the Gonadotropin-releasing
graafian follicle ruptures.
hormone to initiate menstrual cycle.
- The ovum is set free from the surface of the ovary, a process termed
- When the level of estrogen (produced by the ovaries) rises, the release of the
OVULATION. It is swept into the open end of a fallopian tube.
hormone is repressed, and menstrual cycle do not occur (the principle that birth
If a sperm enters the system, then the fertilization occurs in the ampullar
control pills use to eliminate menstrual flow).
area.
- GnRH is transmitted from the hypothalamus to the anterior pituitary gland and
- Teach women that ovulation occurs on approximately the 14th day before the
signals the gland to begin producing the gonadotropic hormones FSH and LH.
onset of the next cycle, not necessarily at the cycle’s midpoint
Because production of GnRH is cyclic, menstrual periods also cycle.
- The basal body temperature of a woman drops slightly (by 0.5 ͦ to 1 ͦ F) just
before the day of ovulation, because of the extremely low level of
B. Pituitary Glands
progesterone that is present at that time.
- Under the influence of GnRH, the anterior lobe of the pituitary gland
- It rises 1 ͦ F on the day after ovulation, because of the concentration of
(adenohypophysis) produces two hormones that act on the ovaries to further
influence the menstrual cycle: progesterone (which is thermogenic) that is present at that time.
1. FSH – a hormone that is active early in the cycle and is - If conception (fertilization by a spermatozoon) occurs as the ovum proceeds
responsible for maturation of the ovum down a fallopian tube and the fertilized ovum implants on the endometrium of
2. LH – a hormone that becomes most active at the midpoint of the the uterus, the corpus luteum remains throughout the major portion of the
cycle and is responsible for ovulation, or release of the mature egg pregnancy (approximately 16 to 20 weeks).
- If conception does not occur, the unfertilized ovum atrophies after 4 or 5
C. Ovary days, and the corpus luteum (called das “false” corpus luteum) remains for
only 8 to 10 days. As the corpus luteum regresses, it is gradually replaced by

Page 11 of 21 © ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL

RTRMF – COLLEGE OF NURSING
LEVEL II
white fibrous tissue, and the resulting structure is termed a corpus albicans
(white body).
D. Uterus
1. First Phase of Menstrual Cycle (PROLIFERATIVE)
- The endometrium, or lining of the uterus, is very thin, approximately one
cell layer in depth.
- As the ovary begins to produce estrogen (in the follicular fluid, under the
direction of the pituitary FSH), the endometrium begins to proliferate.
- This growth is very rapid and increases the thickness of the endometrium
approximately eightfold.
2. Second Phase of Menstrual Cycle (SECRETORY)
- After ovulation, the formation of progesterone in the corpus luteum
(under the direction of LH) causes the glands of the uterine endometrium
to become corkscrew or twisted in appearance and dilated with
quantities of glycogen (an elementary sugar) and mucin (a protein).
- The capillaries of the endometrium increase in amount until the lining
takes on the appearance of rich, spongy velvet.
- This second phase of the menstrual cycle is termed the progestational,
luteal, premenstrual, or secretory phase.
3. Third Phase of Menstrual Cycle (ISCHEMIC)
- If fertilization does not occur, the corpus luteum in the ovary begins to
regress after 8 to 10 days.
- As it regresses, the production of progesterone and estrogen decreases.
- With the withdrawal of progesterone stimulation, the endometrium of the
uterus begins to degenerate (at approximately day 24 or day 25 of the
cycle)
- The capillaries rupture, with minute hemorrhages, and the endometrium
sloughs off.
4. Fourth Phase of a Menstrual Cycle (MENSES)
- Blood from the ruptured capillaries.
- Mucin from the glans
- Fragments of endometrial tissue
- The microscopic, atrophied, and unfertilized ovum
- Menses is actually the end of an arbitrarily defined menstrual cycle.
Because it is the only external marker of the cycle, however, the first day
Page 12 of 21
NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LECTURER: Tatyana Lauren Poblete - Ajero
of menstrual flow is used to mark the beginning day of new menstrual
cycle.
iii. CONSIDERATIONS
 Contrary to common belief, a menstrual flow contains only approximately 30
to 80 mL of blood; if it seems like more, it is because of the accompanying
mucus and endometrial shreds.
 The iron loss in a typical menstrual flow is approximately 11 mg.
 In women who are beginning menopause, menses may typically consist of a
few days of spotting before a heavy flow, or a heavy flow followed by a few
days of spotting, because progesterone withdrawal is more sluggish or tends
to “staircase” withdraw smoothly.
iv. CERVIX
 During the first half cycle, when hormone secretion from the ovary is low,
cervical mucus is thick and scant. Sperm survival in this type of mucus is
poor.
 At the time of ovulation, when the estrogen level is high, cervical mucus
becomes thin and copious. Sperm penetration and survival at the time of
ovulation in this thin mucus are excellent.
 As progesterone becomes the major influencing hormone during the second
half of the cycle, cervical mucus again becomes thick and sperm survival is
again poor.
In the natural means of family planning, which makes use of cervical mucus
to test out if ovulating, the female will get a sample of their cervical mucus
then she needs to stretch it out. If it is thick and easily breaks, it is copious, it
means that the woman is not ovulating.
If watery or runny when stretched out, there is a big possibility that the
woman is ovulating
A. Fern Test
- When high levels of estrogen are present in the body, as they are
just before ovulation, the cervical mucus forms fern-like patterns
caused by the crystallization of sodium chloride on mucus fibers
when it is placed on a glass slide and allowed to dry.
- Cervical mucus can be examined at midcycle to detect whether
ferning, which suggests a high estrogen surge, is present.
B. Spinnbarkeit Test
© ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL
RTRMF – COLLEGE OF NURSING NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LEVEL II LECTURER: Tatyana Lauren Poblete - Ajero

- At the height of estrogen secretion, cervical mucus not only
becomes thin and watery but also can be stretched into long
strands.
- This stretch ability is in contrast to its thick, viscous state when
progesterone is the dominant hormone.
- A woman can do this herself by stretching a mucus sample between
thumb and finger, or it can be tested in an examining room by
smearing a cervical mucus specimen on a slide and stretching the
mucus between the slide and coverslip.
under age 18 should not take aspirin because of the
association between this and Reye’s syndrome.
Rest More rest may be helpful if dysmenorrheal interferes with sleep at
night.
Nutrition Many women need iron supplementation to replace iron lost in
menses. Eating pickles or cold food does not cause
dysmenorrhea.

v. EDUCATION OF MENSTRUATION vii. MENSTRUAL DISORDERS

 Early preparation for menstruation to dispel myths on is important to a
girl’s concept of herself as a woman, because it teaches her to trust her  Dysmenorrhea
body or to think of menstruation as a mark of pride or growing up rather - painful menstruation
than a burden.
 For the purpose of helping them appreciate the cyclic process that a  Menorrhagia
woman’s reproductive system activities and can be active participants in - abnormally heavy menstrual flows
helping plan or prevent the conception of children.
 Metrorrhagia
vi. TEACHING ABOUT MENSTRUAL HEALTH - bleeding in between menstrual periods
- menstrual migraines, and premenstrual dysphoric syndrome
Area of Concern Teaching Points
Exercise Moderate exercise during menses promotes a general sense of V. MENOPAUSE
well-being. Sustained excessive exercise such as, professional - is the cessation of menstrual cycles
athletes maintain, can cause amenorrhea. - menopause occurs is wide, between approximately 40- and 55-years of age with
Sexual relations Not contraindicated during menses although the male should wear a mean age of 51.3
a condom to prevent exposure to body fluid. Heightened or - Menopause can cause physiologic stress as ovaries are a woman’s chief source
decreased sexual arousal may be noticed during this time. of estrogen
Orgasm may increase the amount of menstrual flow. It is - When ovaries begin to atrophy, reducing estrogen production, “hot flashes,”
improbable but not impossible for conception to occur from vaginal dryness, or osteoporosis (lack of bone mineral density [BMD]) occurs.
coitus during menses.
Activities of daily Nothing is contraindicated (many people believe incorrectly that A. Perimenopausal
life activities such as washing the hair or bathing are harmful). - is a term used to denote the period during which menopausal
changes occur.
Pain relief Prostaglandin inhibitors such as ibuprofen (Motrin) are most B. Postmenopausal
effective for menstrual pain. Applying local heat may also be - describes the time of life following final menses
helpful. If a migraine headache occurs, specific drugs for this
are now available, such as sumatripan (Imitrex). Adolescents

Page 13 of 21 © ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL

RTRMF – COLLEGE OF NURSING
LEVEL II
i. TREATMENT MODALITIES FOR MENOPAUSE
 Hormone replacement therapy (HRP) was prescribed extensively to
decrease menopause symptoms because it is believed that this therapy
reduced cardiovascular complications such as atherosclerosis or heart
attacks as well.
 HR is therapy does not appear to reduce cardiac risk to prevent
osteoporosis and may be associated with endometrial cancer,
cerebrovascular accidents (strokes), and perhaps breast cancer.
 Other possibilities are application of estrogen cream or insertion of a
vaginal ring that dispenses low-dose estrogen.
 Low-dose estrogen or testosterone can also be prescribed to increase
sexual libido.
 Practicing Kegel’s exercise can help strengthen bladder supports and
reduce urinary incontinence.
SEXUALITY
● a multidimensional phenomenon that includes feelings, attitudes, and
actions.
● it has both biologic and cultural components.
● it encompasses and gives direction to a person’s physical, emotional, social,
and intellectual responses throughout life.
We have different views on how to approach this, but it’s not to say that
we’re going to allow these differences to put a gap in our relationship in with
our clients.
we must learn how to keep ourselves on a neutral ground, understanding
that not all our thoughts would be the same with the rest, and learn how to
handle those situations.
I. BIOLOGIC GENDER
● is the term used to denote a person’s chromosomal sex: male (XY) or female
(XX).
used in biodata, when we say sex, it is trying to determine whether the
person is biologically male or female
II. GENDER IDENTITY OR SEXUAL IDENTITY
Page 14 of 21
NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LECTURER: Tatyana Lauren Poblete - Ajero
● is the inner sense a person has of being male or female, which may be the
same as or different from biologic gender.
you can be female in your biological gender, and you can feel that you are
actually male when you are trying to consider your gender identity
III. GENDER ROLE
● is the male or female behavior a person exhibits, which, again, may or may
not be the same as biologic gender or gender identity.
behavior depicted by the person, it can be in congruence or opposite with
your biological identity and gender identity
DEVELOPMENT OF GENDER IDENTITY
● SEX TYPING - the process of determining the sex of a person or other organism,
especially in difficult cases where special tests are necessary
● Gender role is also culturally influenced. Culture plays a big role with gender
identification in our country.
● WOMEN have nurturing qualities with sole responsibility for childrearing and
homemaking. MEN were viewed as financial providers.
● Gender roles today are more interchangeable: WOMEN pursue all types of jobs and
careers without loss of femininity, and MEN participate in childrearing and household
duties without loss of masculinity. There are other households wherein the woman is
the one working and the man is tending the children. That is socially accepted but
there are some people that see this as not within the norm.
I. INFANCY
● From the day of birth, female and male babies are treated differently by their
parents.
● People generally bring girls dainty rattles and dresses with ruffles; on the
whole, they are treated more gently by parents and held and rocked more
than male babies.
● People tend to buy boys bigger rattles and sports related jogging suits.
● Boys demonstrate more innate aggression, even at this early stage, than do
girls.
There are also families that are keener on masculinity towards boys and
when it comes to females the approach is gentler and more playful.
II. PRESCHOOL PERIOD
© ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL
RTRMF – COLLEGE OF NURSING
LEVEL II
● By age 3 or 4 years, they can say what sex they are, and they have
absorbed cultural expectations of that sex role.
At this point when they know how to identify what is male and female, they
start to identify themselves where they belong
● Often, boys will play rough-and-tumble games with other boys, and girls will
play more quietly, although the two frequently mix at this age.
● Social contacts between the child and significant adults contribute to sexual
identification and should be encouraged in this developmental period.
● A positive self-concept grows from parental love, effective relationships with
others, success in play activities, and gaining skills and self-control.
III. OEDIPUS COMPLEX
● The preschool boy shows signs of competing with his father for his mother’s
love and attention; (Electra complex) the preschool girl competes with her
mother for her father’s attention and love.
● Parents may need reassurance that this phenomenon of competition and
romance in preschoolers is normal and is only one step in the development
of their child’s gender role identity.
You must reassure the parents that it is expected at their age
IV. SCHOOL-AGE CHILD
● Early school-age children typically spend play time imitating adult roles as a
way of learning gender roles.
● Schools promote differences between males and females by separating
activities into those only for boys and promoting beliefs such as expecting
boys to be proper readers, to write less neatly, and to act rougher in the
school hallways, grade schools have become more attuned to unisex
activities.
● Girls may participate in activities that were once male dominated, such as
Little League and auto repair courses; boys may take cooking or ballet
lessons, formerly the province of girls.
Schools used to do activities wherein whatever activity would be fit for the
male they would only allow males and same for the females.
We must remember that this is a critical age for the child to know that they
can feel safe to whatever gender identification they can feel.
V. ADOLESCENT
Page 15 of 21
NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LECTURER: Tatyana Lauren Poblete - Ajero
● The adolescent begins the process of establishing a sense of identity, the
problem of final gender role identification surfaces again
In Erik Erikson’s theory, when we talk about adolescents, they would fall
under identity vs. role confusion
● Strong ties to their gender group, boys with boys and girls with girls.
● Some adolescents choose a child of their own gender a few years older than
themselves to use as their model of gender role behavior.
● This means that children as young as the early teen years need guidelines
for safer sex. Including such instructions as part of sexual counseling should
help to reduce the incidence of STIs as well as empower adolescents with
better self-care skills. When discussing safer sex practices, be certain that
adolescents understand not only when but how they can incorporate them
into their lifestyle.
Whatever identity they have chosen or tend to follow its not to say that is
already definite, there would be a stage where they would be experimenting
Individuals at this point is adventurous in trying to choose certain activities
they are going to part take on
Its best for us to be able to develop a sense of being informed allowing them
to know the real facts about sexual acts in order for them to reduce the case
of STI
VI. YOUNG ADULT
● Many young adults marry with a commitment to one sexual partner.
● Others establish relationships (cohabitation) that are less binding by legal
definitions but perhaps equally binding in concern and support.
● Homosexuality or bisexuality may be overtly expressed for the first time
during this period.
● Conflicts in parenting can occur if an individual’s gender role does not meet
the expectations of a family, or if an individual’s partner has different
expectations regarding gender role.
At this point you have to be very sensitive with the differences of how a
person views their roles or themselves
● It is time well spent for parents-to-be to take time to discuss with each other
the views they have on parenting to see whether they agree on male and
female roles and their relationship with their children.
© ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL
RTRMF – COLLEGE OF NURSING
LEVEL II
● Conflicts in the roles parents have chosen often come to light for the first time
during pregnancy, as they worry about what type of parents they are going to
be or whether they are adequately prepared to be parents.
It is normal the apprehension of the female not being prepared that is
expected for first time parents
● Early in pregnancy, a woman may experience a decreased desire for coitus
because of the increased estrogen in her body.
VII. MIDDLE-AGE ADULT
● Sexuality has achieved a degree of stability, there is already a sense of
masculinity or femininity and comfortable patterns of behavior have been
established.
● This increased security in identity can promote greater intimacy in sexual and
social relationships.
● This may also be a time when adults allow themselves more freedom in
exploring and satisfying sexual needs.
● Nurses can be instrumental in teaching women what to expect at menopause
so that it is not a surprise and in helping them maintain self-esteem through
this natural process.
specially in patients 40 above where symptoms and menopause would
usually show
● During midlife, men may begin to experience changes in sperm production,
erectile power, achievement of orgasm, and sex drive, although these
changes usually do not significantly alter reproductive or sexual functioning.
● Actual sexual dysfunctions, as a result of physical or psychosocial changes,
may arise at this time.
● Teaching men about normal biophysical changes, providing them with
methods to improve sexual functioning, and offering them support are
important health education roles.
You also have to include in your health teaching about anti-hypertensive
medications, anti-anxiety ants and narcotics
● Certain medications, such as antihypertensives, antianxiety agents, and
narcotics, may diminish sexual response in both men and women.
VIII. OLDER ADULT
Page 16 of 21
NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LECTURER: Tatyana Lauren Poblete - Ajero
● Both male and female older adults continue to enjoy active sexual
relationships.
● Some men experience less erectile firmness or ejaculatory force than when
they were younger, but others discover that they are able to maintain an
erection longer.
● Older women may have less vaginal secretions because they have less
estrogen after menopause.
● Both sexes need to follow safer sex practices throughout life. Because males
remain fertile throughout life, they must continue to be responsible sex
partners in terms of productive planning.
IX. THE INDIVIDUAL WHO IS PHYSICALLY CHALLENGED
● Individuals who are physically challenged have sexual desires and needs the
same as all others.
● They may have difficulty with sexual identity or sexual fulfillment because of
their condition.
● Males with upper spinal cord injury may have difficulty with erection and
ejaculation because these actions are governed at the spinal cord.
● Most women with spinal cord injuries cannot experience orgasm but are able
to conceive and have children.
● People with chronic pain may be too uncomfortable to enjoy sexual relations.
● Individuals with urinary catheters may be concerned about their ability to
enjoy coitus with the catheter in place.
● Encouraging these clients to ask questions and work on specific difficulties is
a nursing role.
● Establishment of a satisfying sexual relationship is an important part of living,
however, so should be included in assessments of clients in rehabilitation
programs.
HUMAN SEXUAL RESPONSE (Masters and Johnson, 1966)
I. EXCITEMENT
© ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL
RTRMF – COLLEGE OF NURSING NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LEVEL II LECTURER: Tatyana Lauren Poblete - Ajero

● BOTH SEXES: There is an increase in heart and respiratory rates and blood
pressure, occurs with physical and psychological stimulation (i.e.,sight,
sound, emotion, or thought) that causes parasympathetic nerve stimulation.
This leads to arterial dilation and venous constriction in the genital area.
● BOTH: Orgasm occurs when stimulation proceeds through the plateau stage
to a point at which the body suddenly discharges accumulated sexual
tension.
● As the shortest stage in the sexual response cycle, orgasm is usually
II. PLATEAU PHASE experienced as intense pleasure affecting the whole body, not just the pelvic
area. It is also a highly personal experience:

IV. RESOLUTION
● 30-minute period during which the external and internal genital organs return
to an unaroused state.
● For the male, a refractory period occurs during which further orgasm is
impossible.
● BOTH: Heart rate increases to 100 to 175 beats per minute and respiratory ● Women do not go through this refractory period, so it is possible for women
rate to approximately 40 respirations per minute. who are interested and properly stimulated to have additional orgasms
immediately after the first.
III. ORGASM
CONTROVERSIES ABOUT THE FEMALE ORGASM

● Freud, who deducted that there were two types of female orgasms: clitoral and
vaginal.

Page 17 of 21 © ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL

RTRMF – COLLEGE OF NURSING
LEVEL II
● He believed that clitoral orgasms (originating from masturbation or other noncoital
acts) represented sexual immaturity and that only vaginal orgasms were the
authentic, mature form of sexual behavior in women.
● Masters (1998) showed that there is no physiologic difference between an orgasm
achieved through intercourse and one achieved by direct stimulation of the clitoris.
● Women have reported a difference in intensity and character between orgasms
achieved through coitus and through other means, but there is no physiologic
difference between them.
● For most women, adequate time for foreplay is essential for them to be orgasmic.
● The G spot
- described in 1950 by the German physician Grafenberg, the G spot,
presumably located on the inner portion of the vaginal wall, halfway between
the pubic bone and the cervix, has been promoted as an area of heightened
erotic sensitivity.
-
LUTEAL PHASE EFFECT ON SEXUAL RESPONSE
● During the second half of the menstrual cycle--the luteal phase--there is increased
fluid retention and vasocongestion in a woman’s lower pelvis.
● Women also may be more interested in initiating sexual relations at this time.
The female enhances to have more responses when it comes to having sexual
relations with their partners
INFLUENCE OF PREGNANCY ON SEXUAL RESPONSE
Page 18 of 21
NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LECTURER: Tatyana Lauren Poblete - Ajero
● Pregnancy is another time in life when there is vasocongestion of the lower pelvis
because of the blood supply needed by a rapidly growing fetus.
● This causes some women to experience a first orgasm during their first pregnancy.
● Following a pregnancy, many women experience increased sexual; interest because
the new growth of blood vessels during pregnancy lasts for some time and continues
to facilitate pelvic vasocongestion.
Pregnant women have higher libido
● At a time when a woman may want sexual contact very much, she needs to be free
of myths and misconceptions, such as the notion that orgasm will cause a
spontaneous miscarriage.
● Although the level of oxytocin does appear to rise in women after orgasm, this rise is
not sufficient to lead to worry that sexual relations will to premature labor in the
average woman.
● The increased breast engorgement that accompanies pregnancy results in extreme
breast sensitivity during coitus.
SEXUAL ORIENTATION
I. Heterosexuality
● a heterosexual is a person who finds with a member of the opposite gender.
● because interest in the opposite sex and sexual relationships may begin as
early as the beginning of the puberty, it is important to provide information on
safer sex practices and planning for their use to children as young as 10-12
years of age.
II. Homosexuality
● a person who finds sexual fulfillment with a member of his or her own sex.
● Many homosexual men prefer to use the term “gay”. “Lesbian” refers to a
homosexual woman.
● Evidence that this orientation is genetically determined or develops because
of the effect of an unusual level of estrogen or testosterone in utero is
increasing.
● Even before puberty, most individuals who are homosexual know they are
“different” in that they are not interested in opposite-sex.
● It is during adolescence, in seeking a sense of identity, that they realize that
the reason they feel “different” is because they are homosexual.
● Young adulthood is the most persons begin to assume a homosexual
lifestyle.
© ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL
RTRMF – COLLEGE OF NURSING
LEVEL II
● Many young adults are worried about the stigma of being labeled
homosexual and therefore keep their identity secret from heterosexual
acquaintances.
● Because the period of identity confusion during adolescence can be so
traumatic to people with alternative lifestyles, it is important for health care
providers to be extremely sensitive to needs in this area.
● Men who have sex with men may need additional counseling to help them
avoid acquiring HIV and other STIs.
● If women who have sex with women cohort with bisexuals, they have the
same risk of STIs as other people.
III. Bisexuality
● People are said to be bisexual if they achieve sexual satisfaction from both
homosexual and heterosexual relationships.
● Like men who have sex with men, bisexual men may be at a greater risk for
HIV and STIs than are others.
● Female partners of bisexual men need to be aware that they are also at
increased risk for HIV and other STIs.
IV. Transsexuality
● Transgender person is an individual who, although of one biologic gender,
feels as if he or she is of the opposite gender.
● Such people may have sex change operations so that they appear
cosmetically as the gender they feel that they are.
● Such operations do not change the person’s chromosomal structure,
however, so although capable of sexual relations in this new role (a synthetic
vagina or penis is created), the person is incapable of reproduction.
SEXUAL ABSTINENCE
● is separation from sexual activity.
● It is the avowed state of certain religious orders.
● It is also a way of life for many adults and one that is becoming fashionable among a
growing number of young adults.
● It is the main point of many high school sex education classes.
● is the most effective way to prevent pregnancy or an STI.
MASTURBATION
Page 19 of 21
NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LECTURER: Tatyana Lauren Poblete - Ajero
● is self-stimulation for erotic pleasure; it can be a mutually enjoyable activity for sexual
partners.
● It offers sexual release, which may be interpreted by the person as overall tension or
anxiety relief.
● Children between 2 and 6 years of age discover masturbation as an enjoyable
activity as they explore their bodies.
● They do this without any attempt at concealment.
● School age children continue to use masturbation for enjoyment or to relieve tension,
but they perform such activities in private. There is no malice in such action.
● Autoerotic asphyxia is the extreme practice of causing oxygen deficiency (usually by
hanging) during masturbation with the goal of producing a feeling of extreme sexual
excitement.
EROTIC STIMULATION
● Erotic stimulation is the use of visual materials such as magazines or photographs for
sexual arousal.
● Some parents of adolescents may need to be assured that an interest in this type of
material is developmental and normal.
● Respect this type of reading material when straightening patients’ rooms in a health
care facility.
FETISHISM
● Fetishism is sexual arousal resulting from the use of certain objects or situations.
● Leather, rubber, shoes, and feet are frequently perceived to have erotic qualities.
● The object of stimulation does not just enhance the experience; rather, it becomes a
focus of arousal, and a person may come to require the object or situation for
stimulation.
TRANSVESTISM
● is an individual who dresses in the clothes of the opposite sex. Transvestites can be
heterosexual, homosexual, or bisexual. Many are married.
● Some transvestites, particularly married heterosexuals, may be under a great deal of
strain to keep their lifestyle a secret from friends and neighbors.
VOYEURISM
● Obtaining sexual arousal by looking at another’s person’s body.
© ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL
RTRMF – COLLEGE OF NURSING
LEVEL II
● Almost all children and adolescents pass through a stage when voyeurism is
appealing; this passes with more active sexual expressions.
● That some voyeurism exists in almost everyone is illustrated by the large number of
R rated movies shown on television and in movie theaters and by the erotic
descriptions in modern novels.
SADOMASOCHISM
● involves inflicting pain (sadism) or receiving pain (masochism) to achieve sexual
satisfaction.
● It is a practice generally considered to be within the limits of normal sexual
expression as long as the pain involved is minimal and the experience is satisfying to
both sexual partners.
OTHERS
● Exhibitionism is revealing one’s genitals in public.
● Bestiality is sexual relations with animals.
● Pedophiles are individuals who are interested in sexual encounters with children.
Known pedophiles are registered as sex offenders. When they move into a new
community, families are notified of the move according to Megan’s Law, a national
law designed to alert citizens to the presence of a sex offender in a community.
SEXUAL HARASSMENT
● It is unwanted and repeated sexual advances, remarks, or behavior toward another
that
○ (a) is offensive to the recipient and
○ (b) interferes with job or school performance
● Rules apply to same-gender as well as opposite-gender harassment.
● In addition to causing occupational disruption, sexual harassment may be so
distressing that it leads to short- and long-term psychosocial consequences for
victims and their families such as emotional distress (anxiety, depression,
posttraumatic stress disorder, substance abuse), interpersonal conflict, and impaired
intimacy and sexual functioning.
DISORDERS OF SEXUAL FUNCTIONING
I. Inhibited Sexual Desire
● Lessened interest in sexual relations is normal in some circumstances, such
as after the death of a family member, a divorce, or a stressful job change.
● Chronic diseases, such as peptic ulcers or chronic pulmonary disorders.
Page 20 of 21
NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LECTURER: Tatyana Lauren Poblete - Ajero
● Obese men and women may not feel as much satisfaction from sexual
relations as others, because they have difficulty achieving deep penetration
because of the bulk of their abdomens.
● An individual with an STI such as genital herpes may choose to forgo sexual
relations rather than inform a partner of the disease.
II. Premature Ejaculation
● ejaculation before penile-vaginal contact
● The term also is often used to mean ejaculation before the sexual partner's
satisfaction has been achieved.
● Premature ejaculation can be unsatisfactory and frustrating for both partners.
● Cause can be psychological. Masturbating to orgasm (in which orgasm is
achieved quickly because of lack of time) may play a role.
● Other reasons suggested are doubt about masculinity and fear of
impregnating a partner, which prevent the man from sustaining an erection
III. Persistent Sexual Arousal Syndrome
● Because the reproductive system has a sensitive nerve supply, when pain
occurs in response to sexual activities, it can be acute and severe and impair
a person's ability to enjoy this segment of their life.
IV. Vaginismus
● involuntary contraction of the muscles at the outlet of the vagina when coitus
is attempted that prohibits penile penetration.
● Vaginismus may occur in women who have been raped.
● Other causes are unknown, but it could also be the result of early learning
patterns in which sexual relations were viewed as bad or sinful.
● As with other sexual problems, sexual or psychological counseling to reduce
this response may be necessary.
V. Dyspareunia and Vestibulitis
● a is pain during coitus. This can occur because of endometriosis (abnormal
placement of endometrial tissue), vestibulitis (inflammation of the vestibule),
vaginal infection, or hormonal changes such as those that occur with
menopause and cause vaginal drying.
● A psychological component may be present.
● Treatment is aimed at the underlying cause.
● Encouraging open communication between sexual partners can be
instrumental in resolving the problem
© ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL
RTRMF – COLLEGE OF NURSING NCM 106 (CARE OF MOTHER, CHILD, & ADOLESCENT)
LEVEL II LECTURER: Tatyana Lauren Poblete - Ajero

OTHER IMPORTANT POINTS

● The reproductive and sexual organs form early in intrauterine life; full
functioning occurs at puberty.
● Educating people about reproductive function is an important primary health
strategy because it teaches people to better monitor their own health through
vulvar or testicular self-examination.
Teach adolescents that with sexual maturity comes sexual responsibility. They need to be
aware of safer sex practices as protection against both an STI or an unintentional pregnancy.

Page 21 of 21 © ABAKA – DIRECTIONERS – MARINURSE – NINJA TURTLES – OLIVER’S TRAVEL