Female Reproductive System


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Female Reproductive System

  1. 1. STI Global City College of NursingLecture Notes on Female Reproductive System SystemPrepared By: Mark Fredderick R Abejo R.N, MAN STI COLLEGE GLOBAL CITY College of Nursing MEDICAL AND SURGICAL NURSING Female Reproductive System Lecturer: Mark Fredderick R. Abejo RN, MAN Anatomy and Physiology of the Female Reproductive SystemMedical and Surgical Nursing 1 Abejo
  2. 2. STI Global City College of NursingLecture Notes on Female Reproductive System SystemPrepared By: Mark Fredderick R Abejo R.N, MANInternal Female Reproductive System Labia Majora W/ hair outside but smooth insideVagina fatty skin folds from MONS PUBIS to PERINEUM and Birth canal protects the labia minora , urinary meatus & vagina Muscular tube (8 cm) Connects cervix of the uterus to the exterior Labia Minora Receives erect stimulus during sexual intercourse Thin, pink, smooth, hairless, extremely sensitive to Opens to outside pressure, touch and temperature. The glands of labia minora lubricate the vulva.Cervix It is formed by the frenulum and the prepuce of the Neck-like part clitoris which is also very sensitive Entrance to uterus Capable of very wide dilation during childbirth Clitoris Composed of glans & shaft that is partially covered byUterus (womb) prepuce Virtually at a right angle to the vagina GLANS is small and round and is filled w/ many nerve Specialized to allow the embryo to become implanted in its endings and rich blood supply inner wall and to nourish the growing fetus from the SHAFT is a cord connecting the glans to the pubic bone; maternal blood w/in it is the major blood supply of clitoris 3 layers:  Peritoneum (outer) Urethral Meatus  Myometrium (middle) – labour, cramps Entrance of urethra, opens approximately 1cm below  Endometrium (inner) – sloughed off every 28 days clitoris during menstrual cycle Skenes GlandFallopian Tube (oviducts) lubricates the external genitalia Found at the top of the uterus on each side Function is to conduct ova (eggs) from the ovary to the Bartholins Gland uterus alkaline in ph, helps improve sperm survival Not physically attached to the ovaries  Fimbraie (finger-like projections) help draw the egg into the fallopian tubes  Right arm = fallopian tube, right hand = fimbraie, left fist = ovary Fertilization occurs near the ovarian end of the fallopian FEMALE REPRODUCTIVE DISORDER tube (must take place within 24 hours of ovulation) Movement of the egg down the fallopian tube is through peristalsis OVARIAN CYSTS Ampulla: site for fertilization  Cysts are nonneoplastic sacs that contain fluid or Isthmus : site for tubal ligation semisolid material.  Ovarian cysts are usually small and produce noOvaries (female gonads) symptoms, ovarian cysts should be thoroughly Main female reproduction organs investigated as possible sites of malignant change. Produces egg cells which are nonmotile  Common types include: Produces steroid hormones (estrogen and progesterone) Follicular,cysts, which are usually very small, Held in place by ligaments semitransparent, and fluid-filled Each ovary contains numerous follicles (“shell”) each Lutein cysts, including corpus luteum cysts, which containing an egg are functional, nonneoplastic enlargements of the Follicle serves as the endocrine gland ovaries All immature eggs are produced before birth Theca-lutein cysts, which are commonly bilateral 30th week of gestation – 7 million eggs and filled with clear, straw-colored fluid At birth – 2 million Polycystic (or sclerocystic) ovary disease is part of Puberty – 300 000 – 400 000 the Stein-Leventhal syndrome. 300 to 400 mature eggs released in a life time  Ovarian cysts can develop any time between puberty and At puberty, 1 mature egg is released every 28 days menopause, including during pregnancy. Will occur usually until the age of 45-50  Corpus luteum cysts occur infrequently, usually during When female has no more eggs to release she goes early pregnancy. into menopause (physiological) Fertilization must take place to complete meiosis II As many as 20 follicles can begin development at the beginning of the menstrual cycle Older eggs have more chances of having problems with the babyExternal Female Reproductive PartsMons Pubis Soft fatty tissue, lies directly over symphysis pubis & becomes covered w/ hair just before puberty It is where the pubic hair grows.Medical and Surgical Nursing 2 Abejo
  3. 3. STI Global City College of NursingLecture Notes on Female Reproductive System SystemPrepared By: Mark Fredderick R Abejo R.N, MANCause / Risk Factors Cause / Risk Factors Follicular cysts arise from follicles that over distend Trasportation---during menstruation, the fallopian tubes instead of going through the atretic stage of the menstrual expel endometrial fragments that implant of the ovaries cycle. or pelvic peritoneum Corpus luteum cysts are caused by excessive Formation in situ--inflammation or a hormonal change accumulation of blood during the hemorrhagic phase of triggers metaplasia (differentiation of coelomic the menstrual cycle. epithelium to endometrial epithelium) Theca-lutein cysts are commonly associated with Induction--this is a combination of transportation and hydatidiform mole, choriocarcinoma, or hormone formation in situ and is the most likely cause. The therapy. endometrium chemically induces undifferentiated Polycystic ovary disease results from endocrine mesenchyma to form endometrial epithelium abnormalities. Clinical ManifestationClinical Manifestation Dysmenorrhea (painful menstruation)-- Pain usually begins 5 to 7 days before menses reaches its peak and last for 2 to 3 days. It is less cramping and less concentrated Usually small cysts produces no symptoms, unless in the abdominal midline than primary dysmenorrheal torsion or rupture causes signs of acute abdomen. pain. Low back pain Lower abdominal pain and in the vagina -- Mild pelvic discomfort Pain to posterior pelvis and back Dyspareunia ( difficult and or painful intercourse) Multiple tender nodules on uterosacral ligaments or in the Abnormal uterine bleeding rectovaginal system. They enlarge and become more Acute abdominal pain (similar to that of appendicitis) -in tender during menses. Ovarian enlargement may also be ovarian cysts with torsion evident. In corpus luteum cysts appearing early in pregnancy, the Other symptoms depend on the location of the ectopic patient may develop unilateral pelvic discomfort and tissue: (with rupture) massive intraperitoneal hemorrhage. Ovaries and oviducts--infertility and profuse menses In polycystic ovary disease, the patient may develop Ovaries or cul-de-sac--deep-thrust dyspareunia (painful amenorrhea ( abnormal absence or stoppage of menses), intercourse) Oligomenorrhea (abnormally infrequent menstruation), or Bladder--suprapubic pain, dysuria (painful or difficulty infertility secondary to the disorder as well as bilaterally urinating), hematuria (Presence of blood in the urine) enlarged ovaries. Rectovaginal septum and colon--painful defecation, rectal bleeding with menses, pain in the coccyx or sacrumCollaborative Management Small bowel and appendix--nausea and vomiting, which worsen before menses, and abdominal cramps Follicular cysts usually dont require treatment because Cervix, vagina, and perineum--bleeding from endometrial they tend to disappear spontaneously within 60 days. deposits in these areas during menses  If they interfere with daily activities, Clomiphene citrate P.O. for 5 days or Diagnostic Test progesterone I.M. for 5 days, reestablishes the Laparoscopy may confirm the diagnosis and determine ovarian hormonal cycle and induces ovulation. the stage of the disease Oral contraceptives may also accelerate involution of Barium enema rules out malignant or inflammatory functional cysts (including both types of lutein cysts and bowel disease. follicular cysts). Treatment for corpus luteum cysts that occur during Collaborative Management pregnancy is symptomatic because these cysts diminish For young women who want to have children during the third trimester and rarely require surgery. includes: androgens, such as danazol, which produce a Theca-lutein cysts disappear spontaneously after temporary remission in Stages I and II. Oral elimination of hydatidiform mole or choriocarcinoma, or contraceptives and progestins also relieve symptoms. discontinuation of HCG or clomiphene citrate therapy. Stage III and IV (when ovarian masses are present), they Polycystic ovary disease treatment may include; drugs, should be removed to rule out cancer. such as clomiphene citrate to induce ovulation or if drug The patient may undergo conservative surgery, but the therapy fails to induce ovulation, surgical wedge treatment of choice for women who dont want to bear resection of one-half to one-third of the ovary. children or who have extensive disease (StageIII and IV) Surgery may become necessary for both diagnosis and is a total abdominal hysterectomy performed with treatment. bilateral salpingo-oophorectomy.ENDOMETRIOSIS UTERINE LEIOMYOMAS ( Myomas / Fibromyomas )  Endometrial tissue appears outside the lining of the  These neoplasms (tumor; any new and abnormal growth) uterine cavity. art the most common benign tumors in women.  This ectopic tissue usually remains in the pelvic area,  They usually occur in the uterine corpus, although they most commonly around the ovaries, uterovesical may appear on the cervix or on the round or broad peritoneum, uterosacral ligaments, and the cul-de-sac, but ligament. it can appear anywhere in the body.  Active endometriosis usually occurs between ages 30 and Cause / Risk Factors 40, more so in women who postpone child-bearing. Uterine Leiomyomas are usually multiple and usually  Endometriosis usually becomes progressively severe occur in women over age 35 during the menstrual years, and subsides after They affect blacks three times more often than whites. menopause. The cause is unknown, but excessive levels of estrogen  Infertility is the primary complication. and human growth hormone (HGH) probably influence  Spontaneous abortion may also occur. tumor formation by stimulating susceptible fibromuscular elements. Large doses of estrogen and the later stages of pregnancy increase both tumor size and HGH levels.Medical and Surgical Nursing 3 Abejo
  4. 4. STI Global City College of NursingLecture Notes on Female Reproductive System SystemPrepared By: Mark Fredderick R Abejo R.N, MAN When estrogen production decreases, uterine leiomyomas Three Types of PID usually shrink or disappear (usually after menopause) Salpingo-oophoritis (fallopian tubes, and ovaries):Clinical Manifestation Acute: sudden onset of lower abdominal and pelvic pain, Pain usually after menses, Submucosal hypermenorrhea (excessive menstrual increased vaginal discharge bleeding, but occurring at regular intervals and being of fever usual duration) malaise Possibly other forms of abnormal endometrial bleeding lower abdominal pressure and tenderness Dysmenorrhea (abnormally painful menses) tachycardia If tumor is large, the patient may develop a feeling of pelvic peritonitis heaviness in the abdomen; Chronic: recurring acute episodes Increasing pain Intestinal obstruction Constipation Urinary frequency or urgency Cervicitis (inflammation of the cervix): Irregular uterine enlargement Acute- purulent, foul-smelling vaginal discharge; Vulvovaginitis, with itching or burningDiagnostic Test Red, edematous cervix Blood studies/ anemia will support the diagnosis Pelvic discomfort D&C (dilatation and curettage) Sexual dysfunction Submucosal hysterosalpingoraphy - detects submucosal Metrorrhagia; infertility; spontaneous abortion leiomyomas Chronic- cervical dystocia, laceration or eversion of the Laparoscopy - visualizes subserous leiomyomas on the cervix, ulcerative vesicular lesion (when cervicitis results uterine surface from herpes simplex virus type II)Collaborative Management Endometritis (inflammation of the uterus): Treatment of choice for women who desire to have Acute- mucoopurulent or purulent vaginal discharge children - A surgeon may remove small leiomyomas that oozing from cervix have caused problems in the past or that appear likely to Edematous, hyperemic endometrium, possible leading to threaten a future pregnancy ulceration and necrosis Tumors that twist or grow large enough to cause Lower abdominal pain and tenderness intestinal obstruction require a hysterectomy, with Fever preservation of the ovaries if possible Rebound pain Pregnant patient: If a patient uterus no larger than a 6 Abdominal muscle spasm month normal uterus by the 16th week of pregnancy, the thrombophlebitis of uterine and pelvic vessels outcome for the pregnancy remains favorable, and Chronic- recurring acute episodes (more common from surgery is usually unnecessary. However if a pregnant multiple sexual partners and sexually transmitted woman has a leiomyomatous uterus the size of a 5 to 6 infections) month normal uterus by the 9th week of pregnancy, spontaneous abortion will probably occur, especially with Cause / Risk Factors a cervical leiomyoma. If surgery is necessary, a PID can result from infection with aerobic or anaerobic hysterectomy is usually performed 5 to 6 months after organisms. delivery (when involution is complete), with preservation Any sexually transmitted infection of the ovaries if possible More than one sex partner Appropriate intervention depends on the severity of Conditions or procedures, such as cauterization of the symptoms, the size and location of the tumors, and the cervix, that alter or destroy cervical mucus, allowing patients age, parity, pregnancy status, desire to have bacteria to ascend into the uterine cavity children, and general health. Any procedure that risks transfer of contaminated Call your doctor immediately if there is any abnormal cervical mucus into the endometrial cavity by bleeding or pelvic pain instrumentation such as use of a biopsy curet Infection during or after pregnancy Infectious foci within the body, such as drainage from aPELVIC INFLAMMATORY DISEASE (PID) chronically infected fallopian tube  Recurrent, acute, subacute, or chronic infection of the oviducts and ovaries, with adjacent tissue involvement. Treatment:  PID may refer to inflammation of the cervix, uterus, Effective management eradicates the infection, relieves fallopian tubes, and ovaries, which can extend to the symptoms, and avoids damaging the reproductive system. connective tissue lying between the broad ligaments (parmetritis). Aggressive therapy with multiple antibiotics begins  Early diagnosis and treatment prevent damage to the immediately after culture specimens are obtained. reproductive system. Infection may become chronic if treated inadequately  Complications of PID may include potentially fatal Supplemental treatment of PID may include bed rest, septicemia, pulmonary emboli, shock and analgesics, and I.V. therapy infertility. Untreated PID may be fatal. Narcotics may be needed, NSAIDs are preferred for pain relief.Clinical Manifestation Development of a pelvic abscess requires adequateClinical features vary with the affected area. drainage. A ruptured pelvic abscess is a life-threatening They may include profuse, purulent vaginal discharge condition. If this complication develops, the patient may Low-grade fever need a total abdominal hysterectomy, with bilateral Malaise salpingo-oophorectomy Lower abdominal painMedical and Surgical Nursing 4 Abejo
  5. 5. STI Global City College of NursingLecture Notes on Female Reproductive System SystemPrepared By: Mark Fredderick R Abejo R.N, MANVAGINAL PROBLEMS Vaginismus: Your doctor may want to refer you to a doctor who specialize in psychology, and or one who specialize in sexualVaginitis Inflammation of the vagina therapy.Most common: Candida vaginitis (yeast infection) topical cream .Candida vaginitis (yeast infection): Studies shows approximately75% of all women will have a yeast infection at least once in theirlifetime. Some will suffer form recurring yeast infections. Vaginalyeast infections may cause pain during urination and or during PREMENSTRUAL SYNDROME: Also called PMS -Thesexual intercourse. effects of this disorder ranges from minimal discomfort to severe, disruptive behavioral and somatic changes. Symptoms usually appear 7 to 14 days before menses and usually subside with itsSymptoms of yeast infection - itching, soreness and may have a onset.white, cottage-cheese-like discharge. Cause: Direct cause unknown, PMS may result from aBacterial vaginosis: For reasons unknown there may be a change progesterone deficiency in the luteal phase ot the menstrual cyclein the balance of naturally occurring bacteria in the vagina that or from an increased estrogen-progesterone ratio. Approximatelyallows disease causing bacteria to dominate. It occurs commonly 10% of patients with PMS have elevated prolactin levelsduring reproductive years. Symptoms:Symptoms - Many women with this infection exhibit no symptoms,but the predominate sign of this condition is a fishy smelling graydischarge. Behavioral changes: Mild to severe personality changes NervousnessTrichomonas vaginitis: (produces a refractory vaginal discharge Hostilityand puritis) - causes itching and irritation of the vulva with Irritabilityincreased vaginal discharge that may be green and frothy. Agitation Sleep disturbanceVaginismus: involuntary spastic constriction of the lower vaginal Fatiguemuscles, usually from fear of vaginal penetration. If severe, this Lethargydisorder may prevent intercourse ( a common cause of Depressionunconsummated marriages). Vaginismus affects females of all agesand backgrounds. Patients usually experience muscle spasm with Somatic changes :constriction and pain on insertion of any object into the vagina, Breast tenderness or swellingsuch as a vaginal tampon, speculum or diaphragm. *Note - Abdominal tenderness or bloatingVaginismus usually has a psychological origins. It occurs usually Joint painafter sexual trauma such as rape or incest. Please seek counseling Headacheand see your doctor. Edema Diarrhea or constipationVaginal cancer: usually occurs primarily in women over the age of Patient may also experience exacerbations of skin50, vaginal cancer is very rare, studies shows approximately 2% of problems such as; ache - respiratory problems suchall gynecological cancers. Once cancer appears on the vagina, it as asthma, and neurologic problems such asmay spread to surrounding tissues, including the bladder, rectum, seizures.vulva and the pubic bone. Diagnosis is made by your doctor withthorough examination with a colposcope and biopsy of any Treatment:suspicious-looking areas. Treated symptomatically: treatment may include;Vulvitis: Inflammation of the vulva. May cause itching, burning Antidepressants, NSAIDs (nonsteroidal anti-and or pain. Pelvic examination and blood test or tests to check for inflammatory drugs),any STD ( sexually transmitted disease ) Vitamins TranquilizersSymptoms: Sedatives ProgestinsVaginitis: Increased vaginal discharge with an offensive odor, Treatment may require; a diet that is low in simpleburning, itching and pain sugars, caffeine, and salt, with adequate amounts of protein, high amounts of complex carbohydrates, and possibly, vitamin supplements formulated forVaginal Cancer: Abnormal discharge and bleeding, firm lesion on PMSany part of the vagina (possible cancer) There is also a self - help groups that exist for women with PMS check in your local area.Vaginismus: muscle constriction, spasm and pain on insertion ofany object into the vagina MENOPAUSE: The mechanisms of menstruation cease toVulvitis: if your vulva is inflamed and itches function. Menopause results from a complex, long term syndrome of physiologic changes, the climacteric-cause by declining ovarianTreatment: function.Your doctor will determine the course of treatment. Treatment for Cause: Physiologic menopause, the normal decline in ovarianmost vaginal disorders is aimed at maintaining proper bacterial function caused by aging, begins in most women between ages 40balance and treating your irritation and discomfort. and 50 and results in infrequent ovulation, decreased menstruation, and eventually, cessation of menstruation ( usually ages 45 - 55)Bacterial vaginitis and trichomonas: Your doctor may prescribe atopical cream and or oral medicationMedical and Surgical Nursing 5 Abejo
  6. 6. STI Global City College of NursingLecture Notes on Female Reproductive System SystemPrepared By: Mark Fredderick R Abejo R.N, MANPathologic menopause (premature menopause), the gradual or Treatment:abrupt cessation of menstruation before age 40, cause unknown,however certain disorders, especially severe infections and Since physiologic menopause is a normal process, it mayreproductive tract tumors, may cause pathologic menopause by not require intervention.seriously impairing ovarian function. Other factors that may incur Atypical or adenomatous hyperplasia requires drugpathologic menopause include malnutrition, debilitation, extreme therapyemotional stress, excessive radiation exposure, and surgical Cystic endometrial hyperplasia doesnt require treatmentprocedures that impair ovarian blood supply. If osteoporosis occurs, calcium is given Estrogen therapyArtificial menopause is the cessation of ovarian function following Women who take estrogen must be monitored regularlyradiation therapy or surgical procedures. to detect possible cancer early. If the uterus remains progestin is recommended in addition to estrogen.Symptoms: FEMALE NFERTILITY: Infertility may be caused by any defect or malfunction of the hypothalamic - pituitary - ovarian axis, such Declining ovarian function and decreased estrogen levels as certain neurologic diseases. Other possible cause include: accompanying all forms of menopause produce various menstrual irregularities; Cervical factors, such as infection and possibly cervical antibodies Decrease in the amount and duration of menstrual flow that immobilize sperm Spotting Episodes of amenorrhea (absence or abnormal stoppage Psychological problems of menses) and polymenorrhea (abnormal frequent menstruation) (possible with hypermenorrhea)-excessive menstrual cycle Ovarian factors These irregularities may last only a few months or may persist for several years before menstruation ceases Tubal and peritoneal factors, such as tubal loss or impairment permanently. secondary to ectopic pregnancy Changes in the bodys systems usually dont occur until after the permanent cessation of menstruation Uterine abnormalities, such as; congenitally absent, double uterus; leiomyomas or Ashermans syndrome, in which the anterior andReproductive system: changes may include; shrinkage of vulval posterior uterine walls adhere because of scar tissue formationstructures and loss of subcutaneous fat, possible leading to atrophicvulvitis; atrophy of vaginal mucosa and flattening of vaginal rugae, Approximately 15% of all couples in the US cannot conceive afterpossibly causing bleeding after coitus or douching; vaginal itching regular intercourse for at least 1 year without contraception. 45 toand discharge from bacterial invasion; and loss of capillaries in the 50% of all infertility is attributed to the female.atrophying vaginal wall, causing the pink, rugose lining to becomesmooth and white. Menopause may also produce excessive vaginaldryness and dyspareunia due to decreased lubrication from thevaginal walls, and decreased secretion from Bartholins glands; a Symptoms:reduction in the size of the ovaries and oviducts; and progressivepelvic relaxation as the supporting structures of the reproductive Diagnosis requires a complete examination and healthtract lose their tone from the absence of estrogen history. Questions includes patients reproductive and sexual function, past diseases, mental state, previous surgery, types ofUrinary system: Atrophic cystitis, resulting from the effects of contraception used in the past, and family historydecreased estrogen levels on bladder mucosa and related structures,may produce pus in the urine (pyuria), painful or difficultyurinating (dysuria), and urgency, and incontinence. May have on Treatment:occasion have blood in the urine (hematuria) Intervention aims to correct the underlying abnormalityBreasts: Menopause may cause reduced breast size or dysfunction within the hypothalamic-pituitary-ovarian complex.Integumentary system: Estrogen deprivation may lead to loss of Hormone therapy may be necessary in hyperactivity ;orskin elasticity and turgor. The patient may have slight alopecia hypoactivity of the adrenal or thyroid gland(balding), and may experience loss of pubic and axillary hair. Progesterone replacement for progesterone deficiency Anovulation requires treatment with clomiphene citrateAutonomic nervous system: Hot flashes and night sweats. Patient If mucus production decreases (an adverse effect ofmay experience vertigo, syncope, tachycardia, dyspnea, tinnitus, clomiphene citrate), small doses of estrogen may beemotional disturbances such as irritability, nervousness, crying given concomitantly to improve the quality of cervicalspells, and fits of anger. Patients may also experience and mucusexacerbation of preexisting neurotic disorders such as; depression, Surgical restoration may correct certain anatomic causesanxiety, and compulsive, manic, or schizoid behavior of infertility, such as fallopian tube obstruction Artificial insemination has proven to be an effective alternative strategy for dealing with infertility problemsVascular and musculoskeletal systems: Menopause may also In vitro (test tube) fertilization has also been successfulinduce atherosclerosis and osteoporosis.Artificial menopause, without estrogen replacement, producessymptoms within 2 to 5 years in 96% of women. Sincemenstruation in both pathologic and artificial menopause oftenceases abruptly, severe vasomotor and emotional disturbances mayresult.Menstrual bleeding after 1 year of amenorrhea may indicateorganic diseaseMedical and Surgical Nursing 6 Abejo