NCM 107: MATERNAL AND CHILD HEALTH NURSING

PPT based lecture

MODULE 2: Reproductive and Sexual Health
Nursing Process – Promotion of Reproductive and Sexual B. Males
Health 1. Increase in weight
Assessment: 2. Growth of testes
1. Interview 3. Growth of face, axillary and pubic hair
2. Physical Examination - observation 4. Voice changes
Nursing Diagnosis: 5. Penile growth
− Health-seeking behaviors related to reproductive 6. Increase in height
functioning 7. Spermatogenesis
− Anxiety related to inability to conceive after 6 months
without birth control Male Reproductive Anatomy and Physiology
− Pain related to uterine cramping from menstruation
− Disturbance in body image related to early A. External structures
development of secondary sex characteristics 1. Scrotum - Rugated, skin-covered, muscular pouch
Outcome identification and planning: suspended from the perineum. Supports the testes and help
− Plan client’s care about reproductive system regulate the temperature of sperm.
− Provide information 2. Testes - 2 ovoid glands, 2 to 3 cm wide, lies in the scrotum;
Encased by white fibrous capsule. Composed of number of
− Plan intervention
lobules containing interstitial cells (Leydig’s cells) and
− Design care
seminiferous tubules
Implementation:
Production of Spermatozoa:
− Educate clients concerning reproductive anatomy and o Hypothalamus (GnRH)
physiology o Ant. Pituitary Gland (FSH and LH)
Outcome evaluation: o FSH – Androgen binding protein (ABP)
− Ongoing evaluation of the reproductive health o LH – testosterone
Reproductive Development
Pubertal development: Secondary sex changes begin
Role of androgen: Hormones responsible for muscular
development, physical growth, and the increase in sebaceous
gland secretions in boys and girls
o Males – produced by adrenal cortex and testes
o Females – produces by adrenal cortex and ovaries
Role of Androgen:
− Development of testes, scrotum, penis, prostate, and
seminal vesicles
− Appearance of pubic, axillary and facial hair
− Laryngeal enlargement and voice change
− Maturation of spermatozoa
− Closure of growth in long bones
Role of estrogen:
− Influences the development of the uterus, fallopian
tubes, and vagina.
− Fat distribution and hair patterns. Early Adolescence:
− Breast development. o Testicular self-examination (tenderness and abnormal
− End to growth (closure of epiphyses of long bones) growth)
o Normal testes:Firm, smooth and egg-shaped
Secondary Sex Characteristics 3. Penis - Composed of 3 cylindrical masses of erectile tissue
A. Girls (pubertal changes) in the penis shaft:
1. Growth spurt • Corpus cavernosa (2 masses)
2. Increase in transverse diameter of pelvis • Corpus Spongiosum
3. Breast development a) Penile artery – branch of pudendal artery
4. Growth of pubic hair b) Glans – bulging, sensitive ridge of tissue at the distal end
5. Onset of menstruation c) Prepuce – retractable casing of the skin
6. Growth of axillary hair
7. Vaginal secretions
Menarche: Average age – 12.5 years
 NCM 107: MATERNAL AND CHILD HEALTH NURSING
PPT based lecture
MODULE 2: Reproductive and Sexual Health
B. Internal Structures
1. Epididymis - Tightly coiled tube, approximately 20 ft.
long. It stores some semen and produces semen by its cells in
the lining
• Problems: Aspermia; Oligospermia
2. Vas Deferens (Ductus Deferens) - a hollow tube
surrounded by arteries and veins; protected by thick fibrous
coating. It carries sperm from epididymis through inguinal
canal to abdominal cavity, ending at the seminal vesicles and
ejaculatory ducts
• Spermatic cord – blood vessels and vas deferens
• Varicocele, Vasectomy
3. Seminal Vesicles - two convoluted pouches; lie along the
lower portion of the posterior surface of the bladder and empty
into the urethra; It secretes semen.
4. Prostate gland - chestnut-sized gland; lies below the
bladder; It secretes thin, alkaline fluid
• Problem: Benign Prostatic Hypertrophy (BPH)
5. Bulbourethral Glands (Cowper’s Glands) - two glands;
lies beside prostate gland and empties into the urethra; It
secretes alkaline fluid that helps counteract action of the acid
secretion of the urethra.
Semen is derived from:
• Prostate gland (60%)
• Seminal vesicles (30%)
• Epididymis (5%)
• Bulbourethral glands (5%)
6. Urethra - hollow tube leading from the base of the bladder,
continues to the outside through the shaft and glans of the penis
approximately 8 inches (18 to 20 cm); It is lined with mucous
membrane.
Female Reproductive Anatomy and Physiology
A. External Structures
1. Mons veneris - Pad of adipose tissue over the symphysis
pubis; It is covered by a triangular course of hair.
• Purpose: Protect the junction of the pubic bone
2. Labia Minora - two hairless folds of connective tissue; It is
abundant with sebaceous glands.
3. Labia Majora - two folds of adipose tissue covered by loose
connective tissue and epithelium
• Purpose: protects external genitalia and distal urethra
and vagina
Other External Organs:
o Vestibule - flattened smooth surface inside the labia
o Clitoris - small, rounded organ of erectile tissue;
covered by prepuce; sensitive to touch and
temperature.
o Skene’s glands (paraurethral glands)
− located lateral to the urinary meatus, on each side
Bartholin’s glands (vulvo-vaginal glands)
− located lateral to the vaginal opening on both sides
Fourchette
− ridge of tissue formed by the posterior joining of
2 labia minor and major
o Perineal muscle or body
− posterior to the fourchette Hymen
− tough, elastic semicircle of tissue
− covers the opening to the vagina in childhood
Vulvar Blood Supply - from pudental artery and a portion of
the inferior rectus artery
• venous return is through the pudendal vein
Vulvar Nerve Supply - from the ilioinguinal and genito-
femoral nerves (L1 level) – ant. portion
• pudendal nerve (S3 level) – post. Portion
 NCM 107: MATERNAL AND CHILD HEALTH NURSING
PPT based lecture
MODULE 2: Reproductive and Sexual Health
B. Internal Structures
1. Ovaries - 4cm long by 2cm in diameter; approximately
1.5cm thick
• Grayish white; appear pitted with minute indentations
• Located close to and both sides of the uterus in lower
abdomen
Function:
a. Produce, mature, and discharge ova
b. Produce estrogen and progesterone
c. Initiates and regulates menstrual cycles
d. Maturation and maintenance of secondary sex
characteristics
Three Principal Divisions:
1. Epithelium 2. Fallopian Tubes - arise from each upper corner of the uterine
2. Cortex body; It is a smooth, hollow tunnel; approximately 10cm in
3. Central medulla length.
Division of Reproductive Cells (Gametes):
Oocytes: formed during first 5 months of intrauterine life (2
million); Contains cell membrane, cytoplasm and nucleus
containing chromosomes.
• reproductive cells only have half the usual number of
chromosomes
• Mitotic division (oocytes)- occurs in intrauterine life
till puberty
• Meiosis (cell reduction division) occurs:
o Male – occurs just before spermatozoa mature
o Female – occurs before ovulation Function:
a. Convey ovum from the ovaries to the uterus
b. Place for fertilization of ovum and sperm
Parts:
Interstitial - 1cm in length; 1 mm in diameter (lumen)
Isthmus - 2 cm in length; Extremely narrow.

3. Ampulla - Longest portion, 5 cm in length

4. Infundibular - most distal segment; funnel shape; 2 cm long;

covered by fimbria (small hairs).

5. Uterus - hollow, muscular, pear-shaped organ

• located in the lower pelvis, posterior to the bladder
and anterior to the rectum
• 5 to 7 cm long, 5 cm wide, widest upper part is 2.5 cm
deep; approximately 60 g (non-pregnant state)
• 9 cm long, 3 cm thick, and 80 g in weight
Functions:
a. Receive the ovum from
the fallopian tube
b. Place for implantation and
Ovum: nourishment during fetal
o 22 autosomes and an X sex chromosomes growth
Spermatozoon: c. Protection to a growing
o 22 autosomes and either an X or Y sex chromosomes fetus
Maturation of Oocytes lies in the ovary; surrounded by a d. Expels fetus from
protective sac or thin layers of cells (primordial follicle) woman’s body
o Primordial follicle – underdeveloped state
 NCM 107: MATERNAL AND CHILD HEALTH NURSING
PPT based lecture
MODULE 2: Reproductive and Sexual Health
Divisions:
a. Corpus (Body) - Uppermost part; forms the bulk of the organ
Fundus:
o Amount of uterine growth
o Force of uterine contractions during labor
o Assess uterus to its non-pregnant state
b. Isthmus - short segment between the body and cervix
1 to 2 mm in length (non-pregnant state).
c. Cervix - lowest portion; represents one third of the uterus
2 to 5 cm long
o Cervical canal – central cavity
✓ Internal cervical os
✓ External cervical os

Uterine and Cervical Coats (layers);

1. Endometrium (mucous membrane) 2 layers:
a. Basal layer
b. Glandular layer
• Endocervix – mucous membrane lining of the cervix
2. Myometrium (muscle fibers) - muscle layer; composed of 3
interwoven layers of smooth muscles (fibers).
Functions:
o constrict tubal junctions
Uterine Deviations
o prevents regurgitation of menstrual flow
o holds internal cervical os closed (pregnancy) • Bicornuate
Myomas or benign uterine tumors • Anteversion
3. Perimetrium (connective tissue) - outermost layer • Retroversion
Function: add strength and support to the structure • Anteflexion
• Retroflexion
Uterine Blood Supply
Large descending abdominal aorta
2 iliac arteries  hypogastric arteries  uterine arteries 
supplies the uterus

Uterine Nerve Supply - supplied by both efferent (motor) and

afferent (sensory) nerves
• Efferent – from T5 to T10 spinal ganglia
• Afferent – join the hypogastric plexus and enter spinal
column at T11 and T12
* Epidural Anesthesia (shown in pic)

Female Reproductive Anatomy and Physiology

(BREAST)
Breasts
− Mammary glands, form from the ectodermic tissue
Uterine Supports: early in utero
1. Posterior ligaments
− located anterior to the pectoral muscle
− Douglas’ cul-de-sac
− Consists of connective tissue and fat deposits
− Culdoscopy or laparoscopy
− Glandular tissue remains undeveloped till first
− Culdocentesis pregnancy begins
2. Broad ligaments
− milk glands is divided by connective tissue partitions
3. Round ligaments
(20 lobes), which produce milk by ACINAR cells
− acts as “stays” to steady the uterus
− delivers milk to the nipple via Lactiferous duct
 NCM 107: MATERNAL AND CHILD HEALTH NURSING
PPT based lecture
MODULE 2: Reproductive and Sexual Health
3. Pubis – forms the anterior portion
• Symphysis pubis – junction of the innominate bones
at the front of the pelvis.

B. Sacrum – forms the upper posterior portion

• Sacral prominence - marked anterior projection
where it touches the lower lumber vertebrae
• Landmark to identify when securing pelvic
measurements
C. Coccyx – below the sacrum, composed of 5 very small,
Nipple fused bones
− Has approximately 20 small openings • Sacrococcygeal joint - Joint between the sacrum and
− Composed of smooth muscles, surrounded by dark coccyx
pigmented area (AREOLA) approximately 4cm in
diameter For Obstetric purposes: Pelvic divisions
− Releases oxytocin 1. False pelvis (superior half)
Areola − Supports the uterus during late months of pregnancy
− Contains many sebaceous glands (montgomery’s − Aids in directing fetus into the true pelvis for birth
tubercle) − Divided from true pelvis by an imaginary line (linea
Ampulla portion of the duct terminalis)
− Located post. to the nipple 2. True pelvis (inferior half)
− Serves as reservoir for milk before BF
Other important terms:
Pelvis 1. Inlet
− supports and protect the reproductive and other pelvic − Entrance to the true pelvis
organs − At the level of linea terminalis
− formed by 4 united bones: − Appears heart-shape (ant. view)
o 2 innominate bones (flaring hip) – anterior and − Wider transversely than anterior posterior diameter
lateral portion 2. Outlet
o Coccyx − Inferior portion of the pelvis
o Sacrum - forms the posterior aspect − Greatest diameter is the anterior posterior diameter
3. Cavity
− Space between the inlet and the outlet
− A curved passage (slow and control the speed of birth)
− Compresses chest at birth (airway)

A. Innominate bones: divided into 3 parts

1. Ilium – forms the upper and lateral portion
• Iliac crest - Flaring superior border; Forms the Types of Pelvis
prominence of the hip.  Android - Male pelvis
2. Ischium – forms the inferior portion  Anthropoid - Ape-like pelvis
• 2 projections at the lowest portion: Ischial tuberosities  Gynecoid - Normal female pelvis
(important landmark to determine pelvic width)  Platypelloid - Flattened pelvis
• Ischial spines - small projections that extend from the
lateral aspects into the pelvic cavity; Marks the
midpoint of the pelvis, used to assess the level to
which the fetus has descended into the birth canal
(station)
 NCM 107: MATERNAL AND CHILD HEALTH NURSING
PPT based lecture
MODULE 2: Reproductive and Sexual Health
Menstruation - Episodic uterine bleeding in response to cyclic • Conception occurs, the corpus luteum remains
hormonal changes approximately 16-20 weeks of pregnancy
o Menstrual cycle – ave. 28 days • No conception – ovum atrophies after 4 or 5 days and
o Menstrual flow – ave. 4 – 6 days Menarche – onset of corpus luteum remains only for 8 – 10 days
o 1st menstrual period: early as age 8 or 9 or late as age − Replaced by white fibrous tissue called corpus
17 albicans (white body)
Purpose: 4. Uterus
− Brings an ovum to maturity Phases:
− Renews uterine tissue bed I. Proliferative (estrogenic, follicular, postmenstrual phase)
immediately after the menstrual flow (1st 4 or 5 days of a cycle)
Characteristics:  endometrium is very thin ovary begins to produce
• Menarche - Ave age at onset (11-13 yrs.)/range (9-17 estrogen,
yrs.  endometrium begins to proliferate (eightfold) till 1 st
• Interval between cycles - Ave (28 days); 23 -35 not half of the cycle (day 5 – 14)
unusual
• Duration - Ave flow (2 -7 days); ranges 1 – 9 not II. Secretory (progestational, luteal, premenstrual phase)
abnormal after ovulation  formation of progesterone in corpus luteum
• Amount - Ave (30 – 80 ml)  causes glands of endometrium become corkscrew and
• Color - Dark red (blood, mucus, endometrial cells) dilated with quantities of glycogen and mucin
• Odor – Similar to marigolds  capillaries increase in amount (like rich, spongy
PHYSIOLOGY OF MENSTRUATION velvet).

1. Hypothalamus – releases GnRH or LHRH that initiates III. Schemic

menstruation transmitted to the anterior pituitary gland that If no fertilization occurs, corpus luteum in the ovary begins to
produces gonadotropic hormones (FSH & LH). regress after 8 – 10 days
2. Pituitary Gland – anterior lobe (adenohypophysis) produces production of progesterone and estrogen  uterus degenerates
2 hormones (FSH & LH) (24th-25th day of cycle)  capillaries rupture with minute
o FSH: Active early in cycle, Responsible for maturation
hemorrhages  endometrium slough off
of ovum
o LH: Active at the midpoint of the cycle, Responsible
IV. Menses (Menstrual cycle)
for ovulation and growth of uterine lining during 2nd
− The end of menstrual cycle
half of menstrual cycle.
3. Ovary - primordial follicle is activated by FSH to begin to − 1st day is used to a mark the beginning day of new
grow and mature. As it grows, cells produce a clear fluid menstrual cycle
(follicular fluid) containing level of estrogen and some − Contains approximately 30 – 80 ml of blood
progesterone at maximum size propelled towards surface of the − 11 mg iron loss during menses
ovary at full maturity visible at the surface as clear water blister Contains: Blood , Mucin, Endometrial tissues, and Unfertilized
(graafian follicle). ovum.
Day 14 (midpoint of typical 28 day cycle): Ovum divided by
mitotic division, CERVIX
1. primary oocyte o 1st half of cycle – cervical mucus is thick and scant
2. secodary oocyte o Ovulation – increase estrogen level, cervical mucus
increase LH (from the pituitary), then releases prostaglandins becomes thin and copious.
that rupture graafian follicle (Ovulation). o 2nd half of cycle – increase progesterone, cervical
graafian follicle after discharge (Ovulation) - 14th day cells mucus becomes thicl
remain in the form of hollow, empty pit. Cervical changes
FSH decreases in amount while LH increases and acts on the (Fern Test) (Spinnbarkeit test)
follicle cells causes production of lutein (bright-yellow fluid)
that fills the empty follicle (corpus luteum or yellow body)

Day before ovulation

Basal body temperature drops slightly by 0.5 – 1 °F
= caused by extremely progesterone
= remains until day 24 of cycle
 NCM 107: MATERNAL AND CHILD HEALTH NURSING
PPT based lecture
MODULE 2: Reproductive and Sexual Health

Education
Dispelling Myths
Menstrual Disorders:
• Dysmenorrhea
• Menorrhagia
• Metrorrhagia
• Amenorrhea
• Polymenorrhea
• Oligomenorrhea

Menopause – Cessation of menstrual cycles.

• Perimenopausal
• Postmenopausal