CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)

(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

FUNCTIONS OF THE REPRODUCTIVE SYSTEM

Module 2: Reproductive • To produce offspring.
and Sexual Health • Gonads produce gametes.
(Sperm or ova) and sex hormones.

UNITIVE AND PROCREATE Sex hormones:

a. Androgens (males)
MARRIAGE b. Estrogens and Progesterone (females)
• “Unite as one flesh” - (sex is unitive).
• MARITAL - meaning is only present when a natural Sex hormones play roles in:
sexual act occurs between a married couple. • Development and functions of the reproductive
• Sex is procreation - Open to the possibility of having organs.
children. • Sexual behavior and drives.
• Growth and development of many other organs
UNITIVE and tissues.
• A specific type of physical union, the sexual union of
a man and a woman in natural intercourse.
GONAD
• In harmony with and ordered towards marital and
procreative.
• Body organ that produces the cells necessary for
PROCREATIVE reproduction
• Only in natural intercourse. • Acquire male or female morphological in the 7th
• Inherently ordered toward the creation of new week of development.
human life. Even if each natural sexual act does not • A pair of longitudinal ridges, the GENITAL OR
produce new life, its ordering toward new life is GONADAL RIDGES.
necessary to have the good moral object of the
procreative meaning. Primary sex organs (gonads):

MARITAL, UNITIVE, PROCREATIVE a. TESTES (male)

An inherently good type of sexual act. However, the
other two fonts of morality — intention and
circumstances — must also be good for the couple to
avoid sin.
REPRODUCTIVE DEVELOPMENT
- Testes produce sperm and lie within the
scrotum.
- Functions of male repro: production of
sperm cells, sustaining and transfer of sperm
cells to female.
- Production of male sex hormones.

INTRAUTERINE DEVELOPMENT b. OVARIES (female)

The sex of an individual is determined at the moment of - Ovaries are the primary female
conception by the chromosome information supplied by reproductive organs,
the particular ovum and sperm that joined to create the - Accessory ducts include: uterine tubes,
new life. uterus, vagina, and mammary gland.
- Functions of female repro: production of
ova, reception of sperm cells from male,
nurturing the development and providing
nourishment for the new individual,
production of female sex hormones.

• At week 5 of intrauterine life, primitive gonadal tissue

is already formed. In both sexes, two
undifferentiated ducts, the MESONEPHRIC (wolffian)
and PARAMESONEPHRIC (mullerian) ducts are
present.

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN
• In females, with no testosterone present, the
urogenital fold remains open to form the labia
minora; what would be formed as scrotal tissue in
the male becomes the labia majora in the female.
• If testosterone secretion is halted in utero -
chromosomal male could be born with female-
appearing genitalia.
• If a woman should be prescribed a form of
testosterone during pregnancy or if the woman,
because of a metabolic abnormality, produces a
high level of testosterone, a chromosomal female
could be born with male-appearing genitalia
(Torresani & Biason-Lauber, 2007).
• 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.
DUQUE, CHRISTINE D.
INDIFFERENT GONADS
• Proliferation of this epithelium and the underlying
mesenchyme produce a bulge on the medical side
pf the mesonephros the GONADAL RIDGE.
• Finger like epithelial cods the GONADAL CORDS
grow into the underlying mesenchyme.
• In an embryo with XX the cortex of the indifferent
gonads differentiates into an OVARY and the
medulla regresses.
• In an embryo with XY the medulla differentiates into
a TESTTIS and the cortex regresses.
DEVELOPMENT OF GONADS
The gonads (testes and ovaries) are derived from 3
sources:
a. Mesothelium (mesoderm epithelium) lining the
posterior abdominal wall.
b. Underlying mesenchyme (embryonic
connective tissue)
c. Primordial germ cells.
PUBERTAL DEVELOPMENT
Stage of life at which secondary sex changes begin.
• 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 hormone
(FSH) and luteinizing hormone (LH).
• FSH and LH initiate the production of androgen and
estrogen, which in turn initiate secondary sex
characteristics, the visible signs of maturity.
PHYSIOLOGY OF MALE REPRODUCTION
• Normal function of the male reproductive system
depends on the hormonal and neutral mechanisms.
Regulation of Sex Hormone Secretion:
- GnRH stimulates LH and FSH release from the
anterior pituitary.
- LH stimulates the interstitial cells to produce
testosterone.
- FSH stimulates sperm cell formation.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

PUBERTY – PHYSIO OF MALE REPRO.

• Before puberty, small amounts of testosterone inhibit

GnRH release.
• During puberty testosterone doe not completely
suppress GnRH releasee, resulting in increased
production of FSH, LH, and testosterone.

Effects of Testosterone: PHYSIOLOGY OF FEMALE REPRODUTION

a. Produced the interstitial cells.
b. Causes development of male sex organs inn the o TESTOSTERONE influences enlargement of the labia
embryo. majora and clitoris and formation of axillary and
c. Sex organs in the embryo. pubic hair.
d. Stimulates descent of the testes.
e. Causes enlargement of the genitalia. Role of Estrogen:
f. Necessary for sperm cell formation.
g. Hair growth stimulation (pubic area, axilla, and a. When triggered at puberty by FSH, ovarian
beard) and inhibition (male pattern baldness). follicles in females begin to excrete a high level
h. Enlargement of larynx & deepening of the of the hormone estrogen.
voice.
i. Increased protein synthesis (muscle), bone This hormone is not one substance but three compounds:
growth, blood cell synthesis, and blood volume. o estrone [E1]
j. Metabolic rate increases. o estradiol [E2]
o estriol [E3]
MALE SEXUAL BEHAVIOR & MALE SEXUAL ACT
b. It can be considered a single substance,
however, in terms of action.
o Testosterone is required for normal sex drive.
The increase in estrogen levels in the female at puberty
The male sexual act includes: influences the development of the:
a. Erection o Uterus
b. Emission o fallopian tubes
c. Ejaculation o Vagina
d. Orgasm typical female fat distribution and hair patterns; breast
e. Resolution development; and an end to growth because it closes
the epiphyses of long bones.
o Stimulation of sexual drive act can be psychic or
tactile.

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

• The beginning of breast development is termed

THELARCHE.

PUBERTY – PHYSIO OF FEMALE REPRO.

• Begins with menarche.

• Girls are beginning dramatic development and
• Begins when GnRH, FSH, LH, estrogen, and
maturation of reproductive organs at earlier ages
progesterone levels increase.
than ever before (9 to 12 years) (McDowell, Brody, &
• Increased in estrogen and progesterone promote
Hughes, 2007).
the development of the female primary and
secondary sexual characteristics.
• Although the mechanism that initiates this dramatic
change in appearance is not well understood, the
hypothalamus, under the direction of the central FEMALE SEXUAL BEHAVIOR & SEXUAL ACT
nervous system, may serve as a gonadostat or
regulation mechanism set to “turn on” gonad
• Female sex drive is partially influential by
functioning at this age.
ANDROGENS (produced by adrenal gland) and
STEROIDS (produced by the ovaries).
• Although it is not proved, the theory is that a girl must
reach a critical weight of approximately 95 lb. (43
Events of the female sexual act includes:
kg) or develop a critical mass of body fat before the
a. Erectile tissue of the clitoris and the bulbs of the
hypothalamus is triggered to send initial stimulation
vestibule become filled with blood.
to the anterior pituitary gland to begin the formation
b. The vestibular glands secrete mucus, and the
of gonadotropic hormones.
vagina extrudes a mucus like substance.
c. Orgasm and resolution occur.
ROLE OF ANDROGEN
• Androgenic hormones are responsible for muscular
development, physical growth, and the increase in
sebaceous gland secretions that causes typical
acne in both boys and girls.

• In males, androgenic hormones are produced by

the adrenal cortex and the testes.

• In females, by the adrenal cortex and the ovaries.

• The level of the primary androgenic hormone,
testosterone, is low in males until puberty
(approximately age 12 to 14 years). At that time,
testosterone levels rise to influence the further
development of the testes, scrotum, penis, prostate,
and seminal vesicles; the appearance of male
pubic, axillary, and facial hair; laryngeal
enlargement and its accompanying voice change;
maturation of spermatozoa; and closure of growth
in long bones.

• In girls, testosterone influences enlargement of the

labia majora and clitoris and formation of axillary
and pubic hair. This development of pubic and
axillary hair because of androgen stimulation is
termed ADRENARCHE.

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

• The production of ova stops at menopause (the end

FERTILIZATION
of the fertile period in females). In contrast, sperm
production is continuous from puberty throughout
• Intercourse must take place 5 days before to 1 day the male’s life.
after ovulation if fertilization is to occur.
• Sperm cells transport to the ampulla depends on the Secondary sex characteristics of boys usually occur in
ability of the sperm cells to swim and possibly on the order of:
contractions of the uterus and the uterine tubes. a. Increase in weight.
• Implantation of the developing embryo into the b. Growth of testes
uterine wall occurs when the uterus is most c. Growth of face, axillary, and pubic hair
receptive. d. Voice changes
e. Penile growth
f. Increase in height.
MENOPAUSE
g. Spermatogenesis (production of sperm)

• The cessation of menstrual cycles. ANATOMY AND PHYSIOLOGY OF THE

• PERIMENOPAUSE – time between the beginning of
irregular menstrual cycle and menopause. REPRODUCTIVE SYSTEM

SECONDARY SEX CHARACTERISTICS GYNECOLOGY

study of the female reproductive organs.
Adolescent sexual development is categorized into
ANDROLOGY
stages (Tanner, 1990). There is wide variation in the time
study of the male reproductive organs.
required for adolescents to move through these
developmental stages; however, the sequential order is
constant. MALE REPRODUCTIVE SYSTEM

In girls, pubertal changes typically are manifest as: MALE EXTERNAL STRUCTURES
a. Growth spurt
b. Increase in the transverse diameter of the pelvis.
c. Breast development
d. Growth of pubic hair
e. Onset of menstruation
f. Growth of axillary hair
g. Vaginal secretions

• The average age at which menarche (the first

menstrual period) occurs is 12.4 years (McDowell et
al., 2007). It may occur as early as age 9 or as late as
age 17, however, and still be within a normal age
range. Irregular menstrual periods are the rule rather
than the exception for the first year.

• Menstrual periods do not become regular until

ovulation consistently occurs with them
(menstruation is not dependent on ovulation), and
this does not tend to happen until 1 to 2 years after 1. TESTES
menarche. This is one reason why estrogen-based
oral contraceptives are not commonly • Two ovoid glands, 2 to 3 cm wide, lie in the
recommended until a girl’s menstrual periods have scrotum. Each testis is encased by a protective
become stabilized or are ovulatory (to prevent white fibrous capsule and is composed of
administering a compound to halt ovulation before several lobules, with each lobule containing
it is firmly established). interstitial cells (Leydig’s cells) and a
• In boys, production of spermatozoa does not begin seminiferous tubule.
in intrauterine life as does the production of ova, nor
are spermatozoa produced in a cyclic pattern as SEMINIFEROUS TUBULES
are ova; rather, they are produced in a continuous • produce spermatozoa.
process. • “Sperm factories”

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

• Surrounding the seminiferous tubules are SPERMATOGENESIS

interstitial cells that produce testosterone.
• The straight tubules rectus conveys sperm to the
RETE TESTIS.
• From the rete testis, the sperm leave the testis via
EFFEENT DUCTULES entering the epididymis.
• LEYDIG’S CELLS - are responsible for the
production of testosterone.
• 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).
• SPERMATOZOA do not survive at a temperature
as high as that of the body, however, so the
location of the testes outside the body, where
the temperature is approximately 1° F lower
than body temperature, provides protection for
sperm survival (McCance & Huether, 2007).
• Beginning in early adolescence, boys need to
learn testicular self-examination so that they can
detect tenderness or any abnormal growth in
the testes.
• Sperm cells (spermatozoa) are produced in the
seminiferous tubules.
• There spermatogenic cells give rise to sperm in a
series of events.
a. Mitosis of spermatogonia, forming
spermatocytes.
b. Meiosis forms spermatids from
spermatocytes.
c. SPERMIOGENESIS – spermatids from
sperm.
• SPERMATOGONIA – outermost cells in contract
with the epithelial basal lamina.
• Spermatogenesis begins at puberty as each
mitotic division of spermatogonia results in type
A or type B daughter cells.
a. TYPE A – cells remain at the basement
membrane and maintain the germ line
b. TYPE B – cells move toward the lumen
and become primary spermatocytes.

• 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.

TESTIS
• Surrounded by 2 tunics:
a. TUNICA VAGINALISIS – derived from
peritoneum.
b. TUNICA ALBUGINEA – the fibrous
capsule of the testis.
• Extension of the tunica albuginea from
incomplete septa.
• SEPTA – divides thew testis into 300 – 400 lobules,
each containing 1 -4 seminiferous tubules.
• During the development, the testes pass from
the abdominal cavity through the inguinal
canal to the scrotum.
• A tunica vaginalis covers such testis, protecting SPERM CELS
against friction. • HEAD
− Nucleus w/ 23 chromosomes
DUCTS ACCESSORY SUPPORTING − ACROSOME, enzyme-filled sac
GLANDS STRUCTURES − Helps the sperm penetrate ovum.
Epididymis Seminal Vesicle Scrotum • MIDPIECE
Ductus Deferens Prostate Gland Penis − Mitochondria that generate cell’s energy.
Urethra Bulbourethral • TAIL
Glands − flagellum that propels sperm forward.

Collectively, all of these structures are called the Male

Genitalia.

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

SUSTENTACULAR CELLS • With sexual excitement, NITRIC OXIDE is released

• nourish the sperm cells.
• Their tights junctions form a blood-testis barrier.
• This prevents sperm antigens from escaping
through the basal lamina into the blood.
• Produces hormones.
2. SCROTUM
• A sac containing the testes.
• A rugated, skin-covered, muscular pouch
suspended from the perineum.
• Functions as a support the testes and to help
regulate the temperature of sperm.
• In very cold weather, the scrotal muscles
contract to bring the testes closer to the body.
• In very hot weather, or in the presence of a
fever, the muscle relaxes, allowing the testes to
fall away from the body.
• In this way, the temperature of the testes can
remain as even as possible to promote the
production and viability of sperm.
• Keep testes 3 degrees Celsius lower than care
body temperature.
from the endothelium of blood vessels. This
results in dilation of blood vessels and an
increase in blood flow to the arteries of the penis
(engorgement).
• 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 distention and erection of
the penis.
• PENILE ATERY - a branch of the pudendal artery,
provides the blood supply for the penis. Penile
erection is stimulated by parasympathetic nerve
innervation.
• 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.
• PREPUCE OR FORESKIN – cuff of skin covering the
glans penis.
• CIRCUMCISION – surgical removal of the foreskin
after birth.

Intrascrotal temperature is kept constant by 2 sets of

muscles:
a. DARTOS – smooth muscle that wrinkles scrotal
skin.
b. CREMASTER – bands off skeletal muscle that
elevate the testes.

MALE INTERNAL STRUCTURES

3. PENIS
• Copulatory organ designed to deliver sperm
into the female reproductive tract.
• Consist of an attached root and a free shaft that
ends in the glans penis.
• Composed of three cylindrical masses of
erectile tissue in the penis shaft:
a. two termed the corpus cavernosa.
b. third termed the corpus spongiosum. 1. EPIDIDYMIS
• Coiled tube system located on the testis that is
• The urethra passes through these layers of the site of sperm cell maturation.
erectile tissue, making the penis serve as the • Consist of head, body, and tail.
outlet for both the urinary and the reproductive
tracts in men. • Responsible for conducting sperm from the
tubule to the vas deferens, the next step in the

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN
passage to the outside. Because each
epididymis is so tightly coiled, its length is
extremely deceptive: it is over 20 ft long.
• Some sperm is stored in the epididymis, and a
portion of the alkaline fluid that will surround
sperm at maturity (semen, or seminal fluid that
contains a basic sugar and mucin, a form of
protein) is produced by the cells lining the
epididymis.
• Because the epididymis is so narrow along its
entire length, infection of the epididymis can
easily lead to scarring of the lumen that then
prohibits passage of sperm beyond the scarred
point.
• Sperm are immobile and incapable of
fertilization as they pass or are stored at the
epididymis level. 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. This is one reason that ASPERMIA
(absence of sperm) and OLIGOSPERMIA (20
million sperm/mL) are problems that do not
appear to respond immediately to therapy but
rather only after 2 months.
2. VAS DEFERENS (DUCTUS DEFERENS)
• An additional hollow tube surrounded by
arteries and veins and protected by a thick
fibrous coating.
• 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 mature 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.
• The blood vessels and vas deferens together are
referred to as the SPERMATIC CORD.
DUQUE, CHRISTINE D.
• A varicocele, or a varicosity of the internal
spermatic vein, was once thought to contribute
to male subfertility by causing congestion with
increased warmth in the testes but this appears
to make little difference (Evers & Collins, 2009).
• VASECTOMY (severing of the vas deferens to
prevent passage of sperm) is a popular means
of male birth control (Cook et al., 2009).
3. EJACULATORY DUCTS
• The two ejaculatory ducts pass through the
prostate gland and join the seminal vesicles to
the urethra.
• canal formed by the union of the vas deferens
and the excretory duct of the seminal vesicle,
which enters the urethra at the prostate gland.
4. URETHRA
• A 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 in (18 to 20 cm) long. Like
other urinary tract structures, it is lined with a
mucous membrane.
• PROSTATIC URRETHRA extends from the urinary
bladder through the prostate gland to the
membranous urethra.
• MEMBRANOUS URETHRA extends through the
pelvic floor and becomes the spongy urethra,
which continues through the penis.
5. SEMINAL VESICLES
• 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.
• Secretes
a. Fluid rich in sugar used to make energy.
b. PROSTAGLANDINS – stimulates muscular
contractions in female to propel sperm
forward.
• SEMINAL FLUID
a. Released into vas deferens.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

b. Just before ejaculation. SEMEN

c. 30% of semen volume. • A thick whitish fluid ejaculated by male during
orgasm, contains spermatozoa and fructose-
• Sperm becomes increasingly motile with this rich nutrients.
added fluid because it surrounds them with • During ejaculation, semen receives
nutrients and a more favorable pH. contributions of fluid form.

6. PROSTATE GLAND a. Prostate gland – 60%

• A chestnut-sized gland that lies just below the b. Seminal vesicle – 30 %
bladder. The urethra passes through the center c. Epididymis – 5%
of it, like the hole in a doughnut. d. Bulbourethral gland – 5%
• Located just below the urinal bladder.
• Secretes alkaline and most of the seminal fluid. • Average pH = 7.5
− The average amount of semen released
a. Surrounds urethra. during ejaculation is 2.5 – 5 ml. It can live
b. Produces and secretes a milky, alkaline fluid with in the female genital tract for about 24
into urethra just before ejaculation. to 72 hours.
c. Fluid protects sperm in the acidic
environment of the vagina. • (500 – 200 million/mL of ejaculation average of
d. 60% semen. 400.
• 90 seconds – cervix
• In middle life, many men develop benign • 5 mins – end of fallopian tube
hypertrophy of the prostate. This swelling
interferes with both fertility and urination. A
benign condition can be relieved by medical FEMALE REPRODUCTIVE SYSTEM
therapy or surgery but needs to be
differentiated from prostate cancer.
FEMALE EXTERNAL STRUTURES
7. BULBOURRETHRAL GLANDS
• Two bulbourethral or Cowper’s glands lie beside 1. VULVA
the prostate gland and empty via short ducts • Latin word for “covering”. It is the structure that
into the urethra. forms the female external genitalia.

a. Pea-sized glands inferior to the prostate.

b. Mucous glands that empty into the
spongy urethra.

• Like the prostate gland and seminal vesicles,

they secrete an alkaline fluid that helps
counteract the acid secretion of the urethra
and ensure the safe passage of spermatozoa.
• Semen, therefore, is derived from the prostate
gland (60%), the seminal vesicles (30%),the
epididymis (5%), and the bulbourethral glands
(5%).

2. MONS VENERIS
• A 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 is to protect the junction of the
pubic bone from trauma.

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN
3. LABIA MAJORA
• Two folds of adipose tissue covered by loose
connective tissue and epithelium are positioned
lateral to the labia minora.
• Longitudinal folds of pigmented skin extend
from the mons pubis to the perineum.
• Covered by pubic hair and serves as protection
for the external genitalia and the distal urethra
and vagina. They are fused anteriorly but
separated posteriorly.
• Trauma to the area, such as occurs from
childbirth or rape, can lead to extensive edema
formation because of the looseness of the
connective tissue base.
4. LABIA MINORA
• Small longitudinal skin folds between labia
majora.
• Just posterior to the mons veneris spread two
hairless folds of connective tissue.
• Before menarche, these folds are small; by
childbearing age, they are firm and full; after
menopause, they atrophy and again become
much smaller.
• Normally the folds of the labia minora are pink;
the internal surface is covered with mucous
membrane, and the external surface with skin.
• The area is abundant with sebaceous glands, so
localized sebaceous cysts may occur here.
• Women who perform monthly vulvar
examinations can detect infection or other
abnormalities of the vulva such as sebaceous
cysts.
OTHER EXTERNAL ORGANS
1. 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.
2. URETHRAL MEATUS
• Small opening between the clitoris and vaginal
orifice for the purpose of urination.
3. VAGINAL ORIFICE/INTROITUS/OPENING
• External opening of the vagina that contains the
hymen.
4. 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. It is sensitive to touch and
temperature and is the center of sexual arousal
and orgasm in a woman.
DUQUE, CHRISTINE D.
• Arterial blood supply for the clitoris is plentiful.
When the ischiocavernosus muscle surrounding
it contracts with sexual arousal, the venous
outflow for the clitoris is blocked, leading to
clitoral erection.
5. TWO SKENE’S GLANDS (paraurethral glands)
• are located just lateral to the urinary meatus,
one on each side. Their ducts open into the
urethra.
6. BARTHOLIN’S GLANDS (vulvovaginal glands)
• are located just lateral to the vaginal opening
on both sides.
• Their ducts open into the distal vagina.
Secretions from both glands help to lubricate the
external genitalia during coitus.
7. The alkaline pH of their secretions helps to improve
sperm survival in the vagina. Both Skene’s glands
and Bartholin’s glands may become infected and
produce a discharge and local pain.
8. 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.
9. Posterior to the fourchette is the perineal muscle or
the perineal body. Because this is a muscular area,
it is easily stretched during childbirth to allow for
enlargement of the vagina and passage of the fetal
head.
10. Many exercises suggested for pregnancy (such as
Kegel’s, squatting, and tailor-sitting) are aimed at
making the perineal muscle more flexible to allow
easier expansion during birth without tearing of this
tissue.
11. HYMEN
• is a tough but elastic semicircle of tissue that
covers the opening to the vagina in childhood.
It is often torn during the time of first sexual
intercourse.
• However, because of the 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. Occasionally, a girl has an
imperforate hymen, or a hymen so complete
that it does not allow for passage of menstrual
blood from the vagina or for sexual relations until
it is surgically incised (Dane et al., 2007).
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

pudendal nerve, further eliminating pain

sensation at the perineum during birth.

12. PERINEUM – tissues between the anus and vagina.

Site of episiotomy.

13. 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 FEMALE INTERNAL STRUCTURES
cause extensive backpressure and
development of varicosities (distended veins) in
the labia majora. Because of the rich blood
supply, trauma to the area, such as occurs from
pressure during childbirth, can cause large
hematomas.
• This ready blood supply also contributes to the
rapid healing of any tears in the area after
childbirth (McCance & Huether, 2007).

1.
14. VULVAR NERVE SUPPLY
• 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. Normal stretching of the perineum
with childbirth causes temporary loss of
sensation in the area. Anesthesia for childbirth
may be administered locally to block the
OVARIES
• Female sex glands located on each side of the
uterus with 2 ovaries.
• (4 x 2 x 1.5 cm thick)
• They are grayish white and appear 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 on the
surface of an ovary.
• Located close to and on both sides of the uterus
in the lower abdomen.
• It is difficult to locate them by abdominal
palpation because they are situated so low in
the abdomen.
• If an abnormality is present, such as an enlarging
ovarian cyst, the resulting tenderness may be

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN
evident on lower-left or lower-right abdominal
palpation.
• The function of the two ovaries (the female
gonads) is to produce, mature, and discharge
ova (the egg cells).
• In the process, the ovaries produce estrogen
and progesterone and initiate and regulate
menstrual cycles.
• If the ovaries are removed before puberty (or
are nonfunctional), the resulting absence of
estrogen prevents breasts from maturing at
puberty; in addition, pubic hair distribution
assumes a more male pattern than normal. After
menopause, or cessation of ovarian function,
the uterus, breasts, and ovaries all undergo
atrophy or a reduction in size because of a lack
of estrogen.
• Ovarian function, therefore, is necessary for
maturation and maintenance of secondary sex
characteristics in females.
• ESTROGEN - secreted by ovaries is also
important to prevent osteoporosis, or weakness
of bones, because of withdrawal of calcium
from bones. This frequently occurs in women
after menopause, making women prone to
serious spinal, hip, and wrist fractures.
• Because cholesterol is incorporated into
estrogen, the production of estrogen is thought
to also keep cholesterol levels reduced, thus
limiting the effects of atherosclerosis (artery
disease) in women.
• ESTROGEN used to be prescribed for women at
menopause to help prevent osteoporosis and
cardiovascular disease. However, this type of
long-term estrogen supplementation may
contribute to breast cancer and
cerebrovascular accidents, so it is no longer
routinely recommended (Kulp & Zacur, 2007).
DUQUE, CHRISTINE D.
Ovaries have three principal divisions:
a. Protective layer of surface epithelium
b. Cortex, where the immature (primordial)
oocytes mature into ova and large amounts of
estrogen and progesterone are produced.
c. Central medulla - contains the nerves, blood
vessels, lymphatic tissue, and some smooth
muscle tissue.
2. FALLOPIAN TUBES
• Arise from each upper corner of the uterine
body and extend outward and backward until
each opens at its distal end, next to an ovary.
• Approximately 10 cm long in a mature woman.
Their function is to convey the ovum from the
ovaries to the uterus and to provide a place for
fertilization of the ovum by sperm.
• A smooth, hollow tunnel is anatomically divided
into four separate parts.
• The most proximal division, the interstitial portion,
is that part of the tube that lies within the uterine
wall. This portion is only about 1 cm in length.
• The lumen of the tube is only 1 mm in diameter
at this point.
• The isthmus is the next distal portion. It is
approximately 2 cm in length and like the
interstitial tube, is extremely narrow. This is the
portion of the tube that is cut or sealed in a tubal
ligation, or tubal sterilization procedure.
• The ampulla is the third and also the longest
portion of the tube. It is approximately 5 cm in
length. It is in this portion that fertilization of an
ovum usually occurs.
• The infundibular portion is the most distal
segment of the tube. It is approximately 2 cm
long and is funnel shaped. The rim of the funnel
is covered by fimbria (small hairs) that help to
guide the ovum into the Fallopian tube.
• The lining of the entire fallopian tube is
composed of mucous membrane, which
contains both mucus-secreting and ciliated
(hair-covered) cells. Beneath the mucous lining
is connective tissue and a circular muscle layer.
• The muscle layer of the tube produces peristaltic
motions that help conduct the ovum the length
of the tube. Migration of the ovum is also aided
by the action of the ciliated lining and the
mucus, which acts as a lubricant.
• The mucus produced may also act as a source
of nourishment for the fertilized egg, because it
contains protein, water, and salts.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN
3. UTERUS
• A hollow, muscular, pear-shaped organ located
in the lower pelvis, posterior to the bladder and
anterior to the rectum.
• During childhood, it is approximately the size of
an olive, and its proportions are reversed from
what they are later (i.e., the cervix is the largest
portion of the organ; the uterine body is the
smallest).
• When a girl reaches approximately 8 years of
age, an increase in the size of the uterus begins.
• An adolescent is closer to 17 years old before
the uterus reaches its adult size. This may be a
contributing factor to the low birth weight
babies typically born to adolescents younger
than this age. With maturity, a uterus is
approximately 5 to 7 cm long, 5 cm wide, and,
in its widest upper part, 2.5 cm deep. In a
nonpregnant state, it weighs approximately
60g.
The function of the uterus:
a. is to receive the ovum from the fallopian
tube.
b. provide a place for implantation and
nourishment.
c. furnish protection to a growing fetus.
d. and maturity of the fetus, expel it from a
woman’s body.
• After a pregnancy, the uterus never returns to its
non-pregnant size but remains approximately 9
cm long, 6 cm wide, 3 cm thick, and 80 g in
weight.
Anatomically, the uterus consists of three divisions:
a. the body or corpus
b. the isthmus,
c. the cervix.
DUQUE, CHRISTINE D.
• The body of the uterus is the uppermost part and
forms the bulk of the organ. The lining of the
cavity is continuous with that of the fallopian
tubes, which enter at its upper aspects (the
cornua).
• During pregnancy, the body of the uterus is the
portion of the structure that expands to contain
the growing fetus. The portion of the uterus
between the points of attachment of the
fallopian tubes is termed the fundus. It is a
portion that can be palpated abdominally to
determine the amount of uterine growth
occurring during pregnancy, to measure the
force of uterine contractions during labor, and
to assess that the uterus is returning to its non-
pregnant state after childbirth. The isthmus of
the uterus is a short segment between the body
and the cervix. In the non-pregnant uterus, it is
only 1 to 2 mm in length.
• During pregnancy, this portion also enlarges
greatly to aid in accommodating the growing
fetus. It is the portion of the uterus that is most
commonly cut when a fetus is born by cesarean
birth.
4. CERVIX
• The cervix is the lowest portion of the uterus. It
represents approximately one third of the total
uterus size and is approximately 2 to 5 cm long.
• Approximately half of it lies above the vagina
and half extends into the vagina. Its central
cavity is termed the CERVICAL CANAL. – Shaped
like a spindle.
• The opening of the canal at the junction of the
cervix and isthmus is the INTERNAL CERVICAL OS.
• Distal opening to the vagina is the ECTERNAL
CERVICAL OS.
• The level of the external os is at the level of the
ischial spines (an important relationship in
estimating the level of the fetus in the birth
canal).
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

5. VAGINA • NERVE SUPPLY: has both parasympathetic and

• A hollow, musculomembranous canal located
posterior to the bladder and anterior to the
rectum. (3-4 inch long)
• FUNCTION: is to act as the organ of intercourse
and to convey sperm to the cervix so that sperm
can meet with the ovum in the fallopian tube.
• With childbirth, it expands to serve as the birth
canal.
• When a woman is lying on her back, as she does
for a pelvic examination, the course of the
vagina is inward and downward.
sympathetic (S-1 to S-3 levels).
• NERVE SUPPLY OF THE ANTERIOR PORTION: (L1)
a. Ilio-inguinal nerves
b. Genito-femoral nerves
• NERVE SUPPLY OF THE POSTERIOR PORTION: (S3)
a. Pudendal nerves
this is the reason why one type of anesthesia used for
childbirth is called PUDENDAL BLOCK.

• ANTERIOR VAGINAL WALL – 6-7cm

• POSTERIOR VAGINALL WALL - 8-9 cm.
• At the cervical end of the structure, there are
recesses on all sides of the cervix, termed
fornices.

• Behind the cervix is the posterior fornix; at the

front, the anterior fornix; and at the sides, the
lateral fornices. The posterior fornix serves as a
place for the pooling of semen after coitus; this
allows a large number of sperm to remain close
to the cervix and encourages sperm migration
into the cervix.

• The vaginal wall is so thin at the fornices that the
bladder can be palpated through the anterior
fornix, the ovaries through the lateral fornices,
and the rectum through the posterior fornix. The
vagina is lined with stratified squamous
epithelium similar to that covering the cervix. It
has a middle connective tissue layer and a
strong muscular wall.
• Normally, the walls contain many folds or rugae
that lie near each other. These folds make the
vagina very elastic and able to expand at the
end of pregnancy to allow a full-term baby to
pass through without tearing.
• 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
exercises).
• 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 also the reason that
any vaginal trauma at birth heals rapidly.
• The vagina has both sympathetic and
parasympathetic nerve innervations originating
at the S1 to S3 levels. The vagina is not an
extremely sensitive organ, however. Sexual
excitement, often attributed to vaginal
stimulation, is influenced mainly by clitoral
stimulation.
• The mucus produced by the vaginal lining has a
rich glycogen content. When this glycogen is
broken down by the lactose-fermenting
bacteria that frequent the vagina (Döderlein’s
bacillus), lactic acid is formed.
• This makes the usual pH of the vagina acid, a
condition detrimental to the growth of
pathologic bacteria, so that even though the
vagina connects directly to the external
surface, infection does not readily occur.
• Instruct women not to use vaginal douches or
sprays as a daily hygiene measure because
they may clean away this natural acid medium
of the vagina, inviting vaginal infections. After
menopause, the pH of the vagina becomes
closer to 7.5 or slightly alkaline, a reason that
vulvovaginitis infections occur more frequently
in women in this age group (Selby, 2007).

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

SUPPORT STRUCTURES − From the inner surface of symphysis pubis; slightly

below the upper border to the sacral promontory; it
is the most important pelvic measurement; it can be
estimated by subtracting 1.5cm – 2cm from
diagonal conjugate.

PELVIS

• Is a bony ring located in the lower portion of the trunk

• The relationship between pelvic size/shape and

f. INTERTUBEROUS CONJUGATE
baby may affect labor or make vaginal delivery
− The outlet between the inner border of the ischial
impossible.
tuberosities should be at least 8cm.

• Two innominate bones which is made up of:

a. ILEUM – upper extended part; curve upper
boarded is the ILIAC CREST.
b. ISCHIUM/ ISCHIA – under part; when sitting the 1.
bony rests on the ischial tuberosities; ISCHIAL 2.
SPINES are important landmark. 3.
• SACRUM – wedge shaped; forms the back part 4.
of the pelvis, consists of 5 fused vertebrae.
• COCCYX – lowest part of the spine. Is made up
of 4 fused rudimentary vertebrae.
PELVIS SHAPES
ANDROID - Narrow heart shaped, male type pelvis.
ANTHROPOID - Narrow oval shaped; resembles ape.
GYNECOID - Classic female pelvis; wide and well-
rounded in all directions.
PLATYPELLOID - Wide but flat, may still allow vaginal
delivery.

Articulation: Pelvic bones are held together by 4 joints:

a. SYMPHYSIS PUBIS – joins the 2 pubis.
b. 2 SACROILLIAC JOINTS – joins the sacrum and
the ileum.
c. SACROCOCCYGGEEAL JOINT – joins the sacrum
and coccyx.

a. SYMPHYSIS PUBIS
− It is the junction of the innominate bone at the front
of the pelvis.
PELVIC DIVISIONS

b. PELVIC MEASUREMENTS 1. FALSE PELVIS - Shallow upper basin of the pelvis

− Measurements are used to determine the fixed size
of the birth canal and the likelihood of a safe vaginal
delivery.
c. TRUE CONJUGATE
− From the upper margin of symphysis pubis to the
sacral promontory, should be at least 11cm, may be
obtained by x-ray or ultrasound.
d. DIAGONAL/OBLIQUE CONJUGATE
− From lower border of symphysis pubis to sacral
promontory; should be 12.5cm to 13cm; may be
obtained by vaginal examination.
e. OBSTETRIC CONJUGATE
supports the enlarging uterus but not important
obstetrically, superior half of the pelvis.
2. LINEA TERMINALIS - Plane divides the upper or false
pelvis from the lower or true pelvis.
3. TRUE PELVIS - Inferior half is formed by the pubes in
front, the iliad and the ischia on the sides and the
sacrum and coccyx behind. It consists of the pelvic
inlet, pelvic cavity, and pelvic outlet. Measurements
of true pelvis influence the conduct and progress of
labor and delivery, Inferior half of the pelvis.
4. INLET - Entranceway to the true pelvis with a
Transverse diameter of 13.5cm, 11cm

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN
anteroposterior diameter and right and left oblique
diameter which measures 12.75cm.
5. CAVITY - Space between the inlet and the outlet
6. OUTLET - Inferior portion of the pelvis, bounded at the
back by the coccyx, on the sides by the ischial
tuberosities and in front by the inferior aspect of the
symphysis pubis and the pubic arch. Its antero-
posterior diameter is wider than its transverse
diameter.
BREASTS
• The mammary glands, or breasts, form from
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. If boys are not
prepared that this is a normal change of puberty,
they may be concerned that they are developing
abnormally. The change is most evident in obese
boys. (Ma & Geffner, 2008).
• Breasts are located anterior to the pectoral muscle
and in many women breasts tissue extends well into
the axilla. Breast self-examinations are not as
effective in detecting early breast lesions as once
believed and so are no longer routinely
recommended (Kosters & Gotzsche, 2007). Women
should have a yearly breast examination done by a
healthcare professional, however, as this can detect
breast disease. 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. The nipple has approximately 20 small
openings through which milk is secreted. An ampulla
portion of the duct, located just posterior to the
nipple, serves as a reservoir for milk before
breastfeeding.
DUQUE, CHRISTINE D.
NIPPLE
• composed of smooth muscle that is capable of
erection on manual or sucking stimulation.
• Raised, pigmented area of the breast.
• On stimulation, it transmits sensations to the
posterior pituitary gland to release oxytocin.
Oxytocin acts to constrict milk gland cells and
push milk forward into the ducts that lead to the
nipple.
AREOLA
• The skin surrounding the nipples is darkly
pigmented out to approximately 4 cm. The area
appears rough on the surface because it
contains many sebaceous glands, called
Montgomery’s tubercles.
• 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.
MONTGOMERY’S TUBERCLES – sebaceous glands of the
areola.
Internal breast structures include:
a. GLANDULLAR TISSUE (parenchyma) – acini (milk
producing cells), which cluster in groups of 15-20 to
form lobes of the breast.
b. LACTIFEROUS DUCTS OR SINUSES – form passageways
from the lobes to the nipple.
c. FIBROUS TISSUE: COOPER’S LIGAMENT – provides
support to the mammary glands.
d. ADIPOSE AND FIBROUS TISSUE (STROMA) – provides
the relative size and consistency of the breasts.
MENSTRUATION
• Episodic uterine bleeding in response to cyclic
hormonal changes.
• PURPOSE: to bring an ovum to maturity and renew a
uterine tissue bed that will be responsible for the
ova’s growth should it be fertilized.
• MENSTRUAL CYCLE / FEMALE REPRODUCTIVE CYCLE –
discharge of blood from the uterus occurring from
puberty to menopause wherein about 30-80 cc of
blood, epithelial cells and mucus are discharged.
• It is the process that allows for conception and
implantation of a new life. Because menarche may
occur as early as 9 years of age, it is good to include
health teaching information on menstruation to
both school age children and their parents as early
as fourth grade as part of routine care. It is a poor
introduction to sexuality and womanhood for a girl
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

to begin menstruation unwarned and unprepared tampon in less than an hour

for the Important internal function it represents. is heavy bleeding
Color of menstrual flow Dark red; a combination of
• The length of menstrual cycles differs from woman to blood, mucus, and
endometrial cells
woman, but the average length is 28 days (from the
Odor Similar to that of marigolds
beginning 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 PHYSIOLOGY OF MENSTRUATION
average menstrual flow (termed MENSESIS 4 to 6
days, although women may have periods as short as Four body structures are involved in the physiology of the
2 days or as long as 7 days (MacKay, 2009). menstrual cycle:
1. Hypothalamus
• Because there is such variation in length, frequency, 2. pituitary gland
and amount of menstrual flow and such variation in 3. ovaries
the onset of menarche, many women have 4. uterus
questions about what is considered normal. Contact
with health care personnel during a yearly health For a menstrual cycle to be complete, all four structures
examination or prenatal visit may be their first must contribute their part: inactivity of any part results in
opportunity to ask questions they have had for some an incomplete or ineffective cycle.
time.

Maturation of Oocytes:
a. First formed utero – 5 to 87 million
b. First 5 months of intrauterine – 2 million immature
oocytes/ovary and the stop.
c. At birth – 2 million on both ovaries.
d. 7 years of age – 500,000 ovaries
e. Reproductive age only – 300 to 400 oocyter
f. Menopause – none

ASSOCIATED TERMS

• AMENORRHEA – markedly diminished menstrual flow.

• MENORRHAGIA – excessive bleeding during regular
menstruation.
• POLYMENORRHEA – frequent menstruations
occurring at intervals of less than 3 weeks.
• OLIOGOMENORRHEA – menstruations occurring at
intervals of more than 35 days.
• DYSMENORRHEA – painful menstruation.

CHARACTERISTICS OF NORMAL MENSTRRUAL

CYCLES

CHARACTERISTICS
Beginning (menarche)
Interval between cycles
Duration of menstrual flow
Amount of menstrual flow
DESCRIPTION
Average age at onset, 12.4
years; average range, 9–17
years
Average, 28 days; cycles of
23–35 days not unusual
Average flow, 2–7 days;
ranges of 1–9 days not
abnormal
Difficult to estimate; average
30–80 mL per menstrual
period; saturating pad or

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN
1. HYPOTHALAMUS
• The release of GnRH (also called luteinizing
hormone–releasing hormone, or LHRH) by the
hypothalamus initiates the menstrual cycle. When
the level of estrogen (produced by the ovaries) rises,
release of the hormone is repressed, and menstrual
cycles do not occur (the principle that birth control
pills use to eliminate menstrual flow).
• During childhood, the hypothalamus is apparently
so sensitive to the small amount of estrogen
produced by the adrenal glands that release of the
hormone is suppressed. Beginning with puberty, the
hypothalamus becomes less sensitive to estrogen
feedback; this results in the initiation every month in
females of the hormone GnRH. GnRH is transmitted
from the hypothalamus to the anterior pituitary
gland and signals the gland to begin producing the
gonadotropic hormones FSH and LH. Because
production of GnRH is cyclic, menstrual periods also
cycle.
• In addition to the inhibitory feedback mechanism of
estrogen and progesterone that halts production of
the releasing factor for the remainder of each
month, high levels of pituitary-based hormones such
as prolactin, FSH, or LH can also inhibit the
production of GnRH.
2. PITUITARY GLAND
Under the influence of GnRH, the anterior lobe of the
pituitary gland (the adenohypophysis) produces two
hormones that act on the ovaries to further influence the
menstrual cycle:
a. FSH, a hormone that is active early in the cycle
and is responsible for maturation of the ovum.
b. LH, a hormone that becomes most active at the
midpoint of the cycle and is responsible for
ovulation, or release of the mature egg cell from
the ovary, and growth of the uterine lining
during the second half of the menstrual cycle.
3. OVARY
• FSH and LH are called GONADOTROPIC HORMONES
because they cause growth (TROPHY) in the gonads
(OVARIES). Every month during the fertile period of a
woman’s life (from menarche to menopause), one
of the ovary’s primordial follicles is activated by FSH
to begin to grow and mature. As it grows, its cells
produce a clear fluid (FOLLICULAR FLUID) that
contains a high degree of estrogen (mainly
DUQUE, CHRISTINE D.
estradiol) and some progesterone. 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 a
graafian follicle.
• By 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 it 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.
• After an upsurge of LH from the pituitary gland,
prostaglandins are released and the graafian follicle
ruptures. The ovum is set free from the surface of the
ovary, a process termed ovulation. It is swept into the
open end of a fallopian tube. Teach women that
ovulation occurs on approximately the 14th day
before the onset of the next cycle, not necessarily at
a cycle’s midpoint. Because periods are typically 28
days, making the 14th day the middle of the cycle,
many women believe incorrectly that the midpoint
of their cycle is their day of ovulation. If their cycle is
only 20 days long, however, their day of ovulation
would be day 6 (14 days from the end of the cycle).
If a cycle is 44 days long, ovulation would occur on
day 30, not day 22.
• After the ovum and the follicular fluid have been
discharged from the ovary, the cells of the follicle
remain in the form of a hollow, empty pit. The FSH
has done its work at this point and now decreases in
amount. The second pituitary hormone, LH,
continues to rise in amount and acts on the follicle
cells of the ovary. It influences the follicle cells to
produce lutein, a bright-yellow fluid. Lutein is high in
progesterone and contains some estrogen, whereas
the follicular fluid was high in estrogen with some
progesterone. This yellow fluid fills the empty follicle,
which is then termed a corpus luteum (yellow body).
• 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
progesterone that is present at that time. It rises by
1° F on the day after ovulation, because of the
concentration of progesterone (which is
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN
thermogenic) that is present at that time. The
woman’s temperature remains at this level until
approximately day 24 of the menstrual cycle, when
the progesterone level again decreases (McCance
& Huether, 2007).
• If CONCEPTION (fertilization by a spermatozoon)
occurs as the ovum proceeds down a fallopian tube
and the fertilized ovum implants on the
endometrium of the uterus, the corpus luteum
remains throughout the major portion of the
pregnancy (approximately 16 to 20 weeks). If
conception does not occur, the unfertilized ovum
atrophies after 4 or 5 days, and the corpus luteum
(called a “false” corpus luteum) remains for only 8 to
10 days. As the corpus luteum regresses, it is
gradually replaced by white fibrous tissue, and the
resulting structure is termed a corpus albicans (white
body).
THE MENSTRUAL CYCLE
FIRST PHASE: PROLIFERATRIVE
Immediately after a menstrual flow (which occurs during
the first 4 or 5 days of a cycle), 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. This increase continues for the
first half of the menstrual cycle (from approximately day
5 to day 14). This half of a menstrual cycle is termed
interchangeably the proliferative, estrogenic, follicular,
or postmenstrual phase.
SECOND PHASE: 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
DUQUE, CHRISTINE D.
cycle is termed the pregestational, luteal, premenstrual,
or secretory phase.
THIRD PHASE: 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.
FOURTH PHASE: MENSES
Menses, or the menstrual flow, is composed of:
• Blood from the ruptured capillaries
• Mucin from the glands
• Fragments of endometrial tissue
• The microscopic, atrophied, and unfertilized
ovum.
MENSES is the end of an arbitrarily defined menstrual
cycle. Because it is the only external marker of the cycle,
however, the first day of menstrual flow is used to mark
the beginning day of a new menstrual cycle.
CERVIX
The mucus of the uterine cervix, as well as the uterine
body, changes each month during the menstrual cycle.
During the first half of the 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.
Women can analyze cervical mucus changes to help
plan coitus to coincide with ovulation if they want to
increase their chance of becoming pregnant or plan to
avoid coitus at the time of ovulation to prevent
pregnancy.
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.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
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This pattern is known as arborization or FERNING. Cervical
mucus can be examined at midcycle to detect whether
ferning, which suggests a high estrogen surge, is present.
Women who do not ovulate continue to show the fern
pattern throughout the menstrual cycle (i.e.,
progesterone levels never become dominant), or they
never demonstrate it because their estrogen levels
never rise.
SPINNBARKEIT TEST
At the height of estrogen secretion, cervical mucus not
only becomes thin and watery but also can be stretched
into long strands. This stretchability contrasts with its thick,
viscous state when progesterone is the dominant
hormone. Performing this test, known as spinnbarkeit, at
the midpoint of a menstrual cycle is another way to
demonstrate that high levels of estrogen are being
produced and, by implication, that ovulation is about to
occur.
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.
MITTELSCHMERZ – abdominal tenderness at either right or
left iliac region.
DUQUE, CHRISTINE D.
REPRODUCTIVE HORMONES THROUGHOUT
MENSTRUATION
GONADOTROPIN-RELEASING HORMONE(GnRH)
− Secreted by the hypothalamus, stimulates anterior
pituitary secretion of FSH and LH.
FOLLICLE STIMULATING HORMONE (FSH)
− Secreted by the anterior pituitary gland, it acts on
an ovarian follicle responsible for maturation of the
ovum.
LUTEINIZING HORMONE
− Secreted by the anterior pituitary gland, it acts on
ovaries to secrete estrogen and is responsible for
ovulation. LH surges to mid cycle to facilitate
ovulation and control the secretion of estrogen and
progesterone by corpus luteum.
ESTROGEN
− Secreted by the ovary (follicle and corpus luteum),
causes proliferation of the endometrium. It is also
responsible in developing and maintaining the
female reproductive organs and secondary sexual
characteristics associated with the adult female.
PROGESTERONE
− Secreted by the corpus luteum; it is the most
important hormone for conditioning and
maintaining the endometrium. It causes the
endometrium to become thick and secretory,
allowing implantation of a fertilized ovum.
• LMP – 1st day of last menstrual period.
• PMP – past menstrual period.
• Next Menstruation, Menstrual Days Cycle, Ovulation
period.