This document provides an overview of the anatomy and physiology of the male and female reproductive systems. It describes various reproductive disorders including dysmenorrhea, abnormal uterine bleeding, premenstrual syndrome, menopause, erectile dysfunction, infertility, and infections of the female reproductive tract. Diagnostic tests and treatments for various reproductive conditions are also discussed.

1. Chapter 12
Care of the Patient with a
Reproductive Disorder
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2. Slide 2
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Overview of Anatomy and
Physiology
• Male reproductive system
 Testes
 Ductal system
• Epididymis
• Ductus deferens (vas deferens)
• Ejaculatory duct and urethra
 Accessory glands
• Seminal vesicles
• Prostate gland
• Cowper’s glands
 Urethra and penis
 Sperm

3. Slide 3
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Figure 12-1
Longitudinal section of the male pelvis showing the location of the
male reproductive organs.
(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)

4. Slide 4
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Figure 12-2
Male sex cell (spermatozoon) greatly enlarged (left). Female sex cell
(ovum) surrounded by sperm at time of fertilization (right).
(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)

5. Slide 5
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Overview of Anatomy and
Physiology
• Female reproductive system
 Ovaries
 Fallopian tubes
 Uterus
 Vagina
 External genitalia
 Accessory glands
• Skene’s glands
• Bartholin’s glands
 Perineum
 Mammary glands (breasts)

6. Slide 6
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Figure 12-3
Longitudinal section of the female pelvis showing the location of the
female reproductive organs.
(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)

7. Slide 7
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Figure 12-4
Sectioned view of the uterus showing relationship to the ovaries and
vagina.
(From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. [13th ed.]. St. Louis: Mosby.)

8. Slide 8
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Figure 12-6
Lateral view of the breast (sagittal section).
(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)

9. Slide 9
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Figure 12-7
Mammalian ovary showing successive stages of ovarian (graafian)
follicle and ovum development.
(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)

10. Slide 10
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Figure 12-14
A, Lymph nodes of the axilla. B, Lymphatic drainage of the breast.
(From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosby’s guide to physical
examination. [5th ed.]. St. Louis: Mosby.)

11. Slide 11
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Human Sexuality
• Sexual identity
 The sense of being feminine or masculine
• Influences on sexual health
 Overall wellness includes sexual health, and sexuality
should be part of the health care program
• Illness and sexuality
 Illness may cause changes in a patient’s self-concept
and result in an inability to function sexually

12. Slide 12
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Laboratory and Diagnostic
Examinations
• Diagnostic tests for the female
 Colposcopy; culdoscopy; laparoscopy
 Papanicolaou (Pap) smear
 Biopsies: Breast, cervical, endometrial
 Conization; dilation and curettage
 Cultures and smears
 Schiller’s iodine test
 Hysterograms
 Mammography; pelvic ultrasonography
 Tubal insufflation (Rubin’s test)
 Human chorionic gonadotropin; serum CA-125

13. Slide 13
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Laboratory and Diagnostic
Examinations
• Diagnostic tests for the male
 Testicular biopsy
 Semen analysis
 Prostatic smears
 Cystoscopy
 Rectal digital exam
 Prostate specific antigen (PSA)

14. Slide 14
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The Reproductive Cycle
• Menarche
 The beginning of menses
 Follows breast development by 2 to 2½ years
 Average age range is between 9 and 17 years
 Cycle length ranges from 24 to 32 days
 The average flow lasts 3 to 5 days
 The average flow is 35 mL/cycle

15. Slide 15
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The Reproductive Cycle
• Amenorrhea
 Etiology/pathophysiology
• Absent or suppressed menstrual flow
 Clinical manifestations/assessment
• No menstrual flow for at least 3 months
 Medical management/nursing interventions
• Based on underlying cause
• Hormone replacement may be necessary

16. Slide 16
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• Dysmenorrhea
 Etiology/pathophysiology
• Uterine pain with menstruation
 Clinical manifestations/assessment
• Breast tenderness; headache
• Abdominal distention; nausea and vomiting
• Vertigo
• Palpitations
• Excessive perspiration
• Colicky, cyclic pain; dull pain in the lower pelvis
The Reproductive Cycle

17. Slide 17
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The Reproductive Cycle
• Dysmenorrhea (continued)
 Medical management/nursing interventions
• Exercise
• Nutritious foods, high in fiber
• Heat to pelvic area
• Mild analgesics
• Prostaglandin inhibitors

18. Slide 18
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The Reproductive Cycle
• Abnormal uterine bleeding
 Menorrhagia
• Excessive bleeding during the regular menstrual flow
• Causes: Endocrine disorders; inflammatory
disturbances; uterine tumors
 Metrorrhagia
• Uterine bleeding between regular menstrual periods or
after menopause
• May indicate cancer or benign tumors of the uterus

19. Slide 19
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The Reproductive Cycle
• Premenstrual syndrome (PMS)
 Etiology/pathophysiology
• Believed to be related to the neuroendocrine events
occurring within the anterior pituitary gland
 Clinical manifestations/assessment
• Irritability, lethargy, and fatigue
• Sleep disturbances; depression
• Headache; backache; breast tenderness
• Vertigo
• Abdominal distention
• Acne

20. Slide 20
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The Reproductive Cycle
• Premenstrual syndrome (PMS) (continued)
 Medical management/nursing interventions
• Pharmacological management
 Analgesics; diuretics; progesterone
• Dietary recommendations
 High in complex carbohydrates
 Moderate in protein
 Low in refined sugar and sodium
 Limit caffeine, chocolate, and alcohol
• Reduce or eliminate smoking
• Exercise; adequate rest, sleep, and relaxation

21. Slide 21
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The Reproductive Cycle
• Menopause
 Etiology/pathophysiology
• The normal decline of ovarian function resulting from
the aging process
• May be induced by irradiation of the ovaries or surgical
removal of both ovaries
• Not considered complete until 1 year after the last
menstrual period

22. Slide 22
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The Reproductive Cycle
• Menopause
 Clinical manifestations/assessment
• Decrease in frequency, amount, and duration of the
normal menstrual flow
• Shrinkage of vulval structures; shortening of the vagina
• Dryness of the vaginal wall; pelvic relaxation
• Loss of skin turgor and elasticity
• Increased subcutaneous fat; decreased breast tissue;
thinning of hair
• Osteoporosis

23. Slide 23
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The Reproductive Cycle
• Menopause (continued)
 Medical management/nursing interventions
• Estrogen therapy
 Premarin
 Provera
• Calcium supplements

24. Slide 24
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The Reproductive Cycle
• Male climacteric
 Etiology/pathophysiology
• Gradual decrease of testosterone levels and seminal
fluid production; 55 to 70 years of age
 Clinical manifestations/assessment
• Decreased erections; decreased seminal fluid
• Enlarged prostate gland; decreased muscle tone
• Loss or thinning of hair
 Medical management/nursing interventions
• Emotional support; treatment for impotence

25. Slide 25
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The Reproductive Cycle
• Erectile dysfunction
 Etiology/pathophysiology
• Inability of an adult man to achieve penile erection
• Types
 Functional
 Anatomical
 Atonic
 Medical management/nursing interventions
• Remove cause if possible
• Treat diseases
• Viagra
• Mechanical devices: penile prosthesis

26. Slide 26
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The Reproductive Cycle
• Infertility
 Etiology/pathophysiology
• Inability to conceive after 1 year of sexual intercourse
without birth control
 Medical management/nursing interventions
• Depends on the cause
• Hormone therapy
• Repair occlusion
• Intrauterine insemination
• In vitro fertilization

27. Slide 27
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Infections of the Female
Reproductive Tract
• Simple vaginitis
 Etiology/pathophysiology
• Common vaginal infection
• Causative organisms: E. coli; staphylococcal;
streptococcal; T. vaginalis; C. albicans; Gardnerella
 Clinical manifestations/assessment
• Inflammation of the vagina
• Yellow, white, or grayish white, curd-like discharge
• Pruritus and vaginal burning

28. Slide 28
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• Simple vaginitis (continued)
 Medical management/nursing interventions
• Douching
• Vaginal suppositories, ointments, and creams
 Organism-specific
• Sitz baths
• Abstain from sexual intercourse during treatment
• Treat partner if necessary
Infections of the Female
Reproductive Tract

29. Slide 29
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• Cervicitis
 Etiology/pathophysiology
• Infection of the cervix
 Clinical manifestations/assessment
• Backache
• Whitish exudate
• Menstrual irregularities
 Medical management/nursing interventions
• Vaginal suppositories, ointments, and creams;
organism-specific
Infections of the Female
Reproductive Tract

30. Slide 30
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• Pelvic inflammatory disease (PID)
 Etiology/pathophysiology
• Any acute, subacute, recurrent, or chronic infection of
the cervix, uterus, fallopian tubes, and ovaries that has
extended to the connective tissues
• Most common causative organisms
 Gonorrhea; streptococcus; staphylococcus; Chlamydia;
tubercle bacilli
• High risk: Surgical and examination procedures; sexual
intercourse (especially with multiple partners);
pregnancy
Infections of the Female
Reproductive Tract

31. Slide 31
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• Pelvic inflammatory disease (PID) (continued)
 Clinical manifestations/assessment
• Fever and chills
• Severe abdominal pain
• Malaise
• Nausea and vomiting
• Malodorous purulent vaginal exudate
 Medical management/nursing interventions
• Antibiotics; analgesics
• Bed rest
Infections of the Female
Reproductive Tract

32. Slide 32
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• Toxic shock syndrome
 Etiology/pathophysiology
• Acute bacterial infection caused by Staphylococcus
aureus
• Usually occurs in women who are menstruating and
using tampons
Infections of the Female
Reproductive Tract

33. Slide 33
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• Toxic shock syndrome (continued)
 Clinical manifestations/assessment
• Usually occurs between days 2 and 4 of the menstrual
period
• Flu-like symptoms; sore throat; headache
• Red macular palmar or diffuse rash
• Decreased urinary output; BUN elevated
• Pulmonary edema
 Medical management/nursing interventions
• Antibiotics; IV fluid therapy; oxygen
Infections of the Female
Reproductive Tract

34. Slide 34
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Disorders of the Female
Reproductive System
• Endometriosis
 Etiology/pathophysiology
• Endometrial tissue appears outside the uterus
• The tissue responds to the normal stimulation of the
ovaries; bleeds each month
 Clinical manifestations/assessment
• Lower abdominal and pelvic pain
• May radiate to lower back, legs, and groin
 Medical management/nursing interventions
• Antiovulatory medications; pregnancy
• Laparoscopy; total hysterectomy

35. Slide 35
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Figure 12-9
Common sites of endometriosis.

36. Slide 36
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• Vaginal fistula
 Etiology/pathophysiology
• Abnormal opening between the vagina and another
organ
 Clinical manifestations/assessment
• Urine and/or feces being expelled from vagina
 Medical management/nursing interventions
• Oral or parenteral antibiotics
• Diet: high protein; increase vitamin C
• Surgery: Repair fistula; urinary or fecal diversion
Disorders of the Female
Reproductive System

37. Slide 37
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Figure 12-10
Types of fistulas that may develop in the vagina and uterus.
(From Herbst, A.L., et al. [1998]. Comprehensive gynecology. [3rd ed.]. St. Louis: Mosby.)

38. Slide 38
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• Displaced uterus
 Etiology/pathophysiology
• Congenital
• Childbirth
• Backward displacement
 Retroversion
 Retroflexion
Disorders of the Female
Reproductive System

39. Slide 39
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• Displaced uterus (continued)
 Clinical manifestations/assessment
• Backache
• Muscle strain
• Leukorrheal discharge
• Heaviness in the pelvic area
 Medical management/nursing interventions
• Pessary
• Uterine suspension
Disorders of the Female
Reproductive System

40. Slide 40
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• Uterine prolapse
 Etiology/pathophysiology
• Prolapse of the uterus through the pelvic floor and
vaginal opening
 Clinical manifestations/assessment
• Fullness in vaginal area
• Backache
• Bowel or bladder problems
• Protrusion of cervix and vaginal walls in perineal area
Disorders of the Female
Reproductive System

41. Slide 41
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Figure 12-11
Uterine prolapse.
(From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosby’s guide to physical
examination. [5th ed.]. St. Louis: Mosby.)

42. Slide 42
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• Uterine prolapse (continued)
 Medical management/nursing interventions
• Pessary
• Surgery
 Vaginal hysterectomy
 Anteroposterior colporrhaphy
Disorders of the Female
Reproductive System

43. Slide 43
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• Cystocele and rectocele
 Etiology/pathophysiology
• Cystocele
 Displacement of the bladder into the vagina
• Rectocele
 Rectum moves toward posterior vaginal wall
Disorders of the Female
Reproductive System

44. Slide 44
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Figure 12-12
A, Cystocele. B, Rectocele.
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and
management of clinical problems. [7th ed.]. St. Louis: Mosby.)

45. Slide 45
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• Cystocele and rectocele (continued)
 Clinical manifestations/assessment
• Cystocele
 Urinary urgency, frequency, and incontinence; pelvic
pressure
• Rectocele
 Constipation; rectal pressure; hemorrhoids
 Medical management/nursing interventions
• Surgical repair
 Anteroposterior colporrhaphy; bladder suspension
Disorders of the Female
Reproductive System

46. Slide 46
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• Leiomyomas of the uterus (fibroids, myomas)
 Etiology/pathophysiology
• Arise from the muscle tissue of the uterus
• Stimulated by ovarian hormones
 Clinical manifestations/assessment
• Pelvic pressure; pain; backache
• Dysmenorrhea; menorrhagia
• Constipation; urinary symptoms
 Medical management/nursing interventions
• Surgery: Myomectomy; hysterectomy
Disorders of the Female
Reproductive System

47. Slide 47
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Figure 12-13
Leiomyomas.
(Redrawn from Novak, E. R., Woodruff, J. D., eds. [1967]. Novak’s gynecologic and obstetric pathology.
[6th ed.]. Philadelphia, Saunders. In McCance, K.L., & Huether, S.E. [2002]. Pathophysiology: the
biologic basis for disease in adults and children. [4th ed.]. St. Louis: Mosby.)

48. Slide 48
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• Ovarian cysts
 Etiology/pathophysiology
• Benign tumors that arise from dermoid cells of the ovary
 Clinical manifestations/assessment
• May be no symptoms
• Palpable on examination
• Disturbance of menstruation
• Pelvic heaviness; pain
 Medical management/nursing interventions
• Ovarian cystectomy
Disorders of the Female
Reproductive System

49. Slide 49
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Cancer of the Female
Reproductive Tract
• Cancer of the cervix
 Etiology/pathophysiology
• Squamous cell carcinoma
• Carcinoma in situ
• If untreated, invades the vagina, pelvic wall, bladder,
rectum, and regional lymph nodes
• High risk
 Sexually active during teens
 Multiple sexual partners
 Multiple births
 Chronic cervical infections

50. Slide 50
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• Cancer of the cervix (continued)
 Clinical manifestations/assessment
• Few symptoms in early stages
• Leukorrhea
• Irregular vaginal bleeding; spotting
• Advanced
 Pain in the back, upper thighs, and legs
Cancer of the Female
Reproductive Tract

51. Slide 51
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• Cancer of the cervix (continued)
 Medical management/nursing interventions
• Carcinoma in situ
 Removal of the affected area
• Early carcinoma
 Hysterectomy
 Intracavitary radiation
• Advanced carcinoma
 Radical hysterectomy with pelvic lymph node dissection
Cancer of the Female
Reproductive Tract

52. Slide 52
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• Cancer of the endometrium
 Etiology/pathophysiology
• Adenocarcinoma of the uterus
 Clinical manifestations/assessment
• Postmenopausal bleeding (50% will have cancer)
• Abdominal pressure; pelvic fullness
 Medical management/nursing interventions
• Surgery: total abdominal hysterectomy with bilateral
salpingo-oophorectomy (TAH-BSO)
• Radiation; chemotherapy
Cancer of the Female
Reproductive Tract

53. Slide 53
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• Cancer of the ovary
 Etiology/pathophysiology
• Fourth most common cause of cancer death in women
• High risk: infertile; anovulatory; nulliparous; habitual
aborters; high-fat diet; exposure to industrial chemicals
Cancer of the Female
Reproductive Tract

54. Slide 54
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• Cancer of the ovary (continued)
 Clinical manifestations/assessment
• Early
 Vague abdominal discomfort
 Flatulence; mild gastric disturbance
• Advanced
 Enlarged abdominal girth
 Flatulence; constipation
 Urinary frequency
 Nausea and vomiting
 Weight loss
Cancer of the Female
Reproductive Tract

55. Slide 55
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• Cancer of the ovary (continued)
 Medical management/nursing interventions
• Surgery
 TAH-BSO and omentectomy
• Radiation and/or chemotherapy
Cancer of the Female
Reproductive Tract

56. Slide 56
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Hysterectomy
• Total hysterectomy
 Removal of the uterus including the cervix
• TAH-BSO
 Removal of the uterus, fallopian tubes, and ovaries
• Radical hysterectomy
 TAH-BSO with removal of the pelvic lymph nodes
• Vaginal hysterectomy
 The uterus is removed through the vagina
• Abdominal hysterectomy
 Abdominal incision is made to perform procedure

57. Slide 57
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Disorders of the Female Breast
• Fibrocystic breast condition
 Etiology/pathophysiology
• Hyperplasia and cystic formation in mammary ducts
 Clinical manifestations/assessment
• Cysts are soft, well-differentiated, tender, and freely
moveable; often bilateral and multiple
 Medical management/nursing interventions
• Eliminate methylxanthines
• Danazol (danocrine); vitamin E

58. Slide 58
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Disorders of the Female Breast
• Acute mastitis
 Etiology/pathophysiology
• Acute bacterial infection of the breast
 Clinical manifestations/assessment
• Breasts are tender, inflamed, and engorged
 Medical management/nursing interventions
• Keep breasts clean
• Application of warm packs
• Support: Well-fitting bra
• Systemic antibiotics

59. Slide 59
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Disorders of the Female Breast
• Chronic mastitis
 Etiology/pathophysiology
• Fibrosis and cysts in the breast
 Clinical manifestations/assessment
• Tender, painful, and palpable cysts
• Usually unilateral
 Medical management/nursing interventions
• Same as for acute mastitis

60. Slide 60
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Disorders of the Female Breast
• Breast cancer
 Etiology/pathophysiology
• Unknown cause; usually adenocarcinoma
 Clinical manifestations/assessment
• Small, solitary, irregular-shaped, firm, non-tender, and
non-mobile tumor
• Change in skin color
• Puckering or dimpling of tissue
• Nipple discharge; retraction of nipple
• Axillary tenderness

61. Slide 61
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Disorders of the Female Breast
• Breast cancer (continued)
 Medical management/nursing interventions
• Depends on the stage
 Radiation
 Chemotherapy
 Surgery
o Lumpectomy
o Mastectomy—simple, radical

62. Slide 62
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Inflammatory Disorders of the Male
Reproductive System
• Prostatitis
 Etiology/pathophysiology
• Acute or chronic infection of the prostate gland
 Clinical manifestations/assessment
• Chills and fever
• Dysuria; urgency and frequency of urination
• Cloudy urine
• Perineal fullness; lower back pain
• Arthralgia; myalgia
• Tenderness, edema, and firmness of the prostate

63. Slide 63
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• Prostatitis (continued)
 Medical management/nursing interventions
• Antibiotics
• Digital massage of the prostate
• Sitz baths
• Monitor I&O
Inflammatory Disorders of the Male
Reproductive System

64. Slide 64
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• Epididymitis
 Etiology/pathophysiology
• Infection of the epididymis
 Clinical manifestations/assessment
• Scrotal pain and edema
• Pyuria; chills and fever
 Medical management/nursing interventions
• Bed rest
• Elevate scrotum; cold compresses
• Antibiotics
Inflammatory Disorders of the
Male Reproductive System

65. Slide 65
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Disorders of Male Genital Organs
• Phimosis
 Etiology/pathophysiology
• Prepuce is too small to allow retraction of the foreskin
over the glans
• Usually congenital; may be due to inflammation or
disease
 Clinical manifestations/assessment
• Infection of foreskin and glans penis
• Occasionally causes obstruction of urine flow
 Medical management/nursing interventions
• Circumcision

66. Slide 66
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Male Genital
Organs
• Paraphimosis
 Etiology and pathophysiology
• An edematous condition of the retracted uncircumcised
foreskin preventing a normal return over the glans
 Medical management/nursing interventions
• Warm compresses
• Circumcision

67. Slide 67
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Male Genital Organs
• Hydrocele
 Etiology/pathophysiology
• Accumulation of fluid between the membranes of the
testes
 Clinical manifestations/assessment
• Enlargement of the scrotum; pain
 Medical management/nursing interventions
• Aspiration of fluid
• Surgical removal of testicular sac
• Bed rest; elevate scrotum; cold compresses

68. Slide 68
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of Male Genital Organs
• Varicocele
 Etiology/pathophysiology
• Dilation of scrotal veins causing obstruction and
malfunction of circulation
 Clinical manifestations/assessment
• Engorgement and elongation of the scrotum
• Pulling sensation in scrotum; dull, aching pain
 Medical management/nursing interventions
• Surgery: Removal of obstruction
• Bed rest
• Elevate scrotum; cold compresses

69. Slide 69
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Cancer of the Male Reproductive
Tract
• Cancer of the testis
 Etiology/pathophysiology
• Cause unknown
 Clinical manifestations/assessment
• Enlarged scrotum; feeling of heaviness
• Firm, painless, smooth mass
 Medical management/nursing interventions
• Radical inguinal orchiectomy
• Radiation and/or chemotherapy
• Teach testicular self-examination

70. Slide 70
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Cancer of the Male Reproductive
Tract
• Cancer of the penis
 Etiology/pathophysiology
• Very rare
 Clinical manifestations/assessment
• Painless, wart-like growth or ulceration, usually on the
glans penis
 Medical management/nursing interventions
• Surgery
 Removal of tissue
 Partial or total amputation of the penis
 Metastasis: Radical surgical procedures

71. Slide 71
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Sexually Transmitted Diseases
• Genital herpes (HSV)
 Etiology/pathophysiology
• Infectious viral disease; usually acquired sexually
 Clinical manifestations/assessment
• Fluid-filled vesicles
• Eventually rupture and develop shallow, painful ulcers
• Fever; malaise
• Dysuria
• Leukorrhea (female)

72. Slide 72
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Figure 12-19
Herpes simplex virus type II in a male and female patient.
(From Beare, P.G., Myers, J.L. [1998]. Adult health nursing. [3rd ed.]. St. Louis: Mosby.)

73. Slide 73
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Sexually Transmitted Diseases
• Genital herpes (HSV) (continued)
 Medical management/nursing interventions
• No cure; treat symptoms
• Acyclovir (Zovirax)
• Sitz baths
• Local anesthetic; analgesics
• Keep lesions clean and dry
• GOOD handwashing
• No sexual contact while lesions are present
• Encourage use of condoms

74. Slide 74
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Sexually Transmitted Diseases
• Syphilis
 Etiology/pathophysiology
• Treponema pallidum organism
• Transmission occurs primarily with sexual contact
 Clinical manifestations/assessment
• Incubation period
 No symptoms
• Primary stage
 Chancre; headaches; enlarged lymph nodes

75. Slide 75
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Sexually Transmitted Diseases
• Syphilis (continued)
 Clinical manifestations/assessment
• Secondary stage
 Rash on palms of hands and soles of feet
 Generalized enlargement of lymph nodes
• Latent stage
 No symptoms
• Tertiary or late stage
 Lesions may affect many different systems; may be fatal

76. Slide 76
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Sexually Transmitted Diseases
• Syphilis (continued)
 Medical management/nursing interventions
• Pharmacological management
 Penicillin
 Tetracycline or erythromycin, if allergic to penicillin
• May be treated in any stage; damage from previous
stages will not be reversed
• Treat all sexual contacts

77. Slide 77
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Sexually Transmitted Diseases
• Gonorrhea
 Etiology/pathophysiology
• N. gonorrhoeae
• Transmitted by sexual contact
 Clinical manifestations/assessment
• Vaginal (female)
 Urinary frequency and pain
 Yellowish discharge
 Nausea and vomiting

78. Slide 78
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Sexually Transmitted Diseases
• Gonorrhea (continued)
 Clinical manifestations/assessment (continued)
• Urethra (male)
 Urethral discomfort; dysuria
 Yellowish discharge containing pus
 Red and swollen meatus
• Rectal (male and female)
 Perineal discomfort; purulent rectal discharge
• Pharyngitis (male and female)
 Sore throat and swallowing discomfort
 Edema of the throat

79. Slide 79
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Sexually Transmitted Diseases
• Gonorrhea (continued)
 Medical management/nursing interventions
• Pharmacological management
 Penicillin
 Rocephin
 Doxycycline or tetracycline
• Patient education
• TREAT ALL SEXUAL CONTACTS

80. Slide 80
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Sexually Transmitted Diseases
• Trichomoniasis
 Etiology/pathophysiology
• T. vaginalis protozoan
• Usually sexually transmitted
 Clinical manifestations/assessment
• Most are asymptomatic
• Male: Urethritis, dysuria, urinary frequency, pruritus,
and purulent exudate

81. Slide 81
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Sexually Transmitted Diseases
• Trichomoniasis (continued)
 Clinical manifestations/assessment (continued)
• Female
 Frothy, gray, green, or yellow malodorous discharge
 Pruritus
 Edema
 Tenderness of vagina
 Dysuria and urinary frequency
 Spotting; menorrhagia; dysmenorrhea

82. Slide 82
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Sexually Transmitted Diseases
• Trichomoniasis (continued)
 Medical management/nursing interventions
• Pharmacological management
 Metronidazole (Flagyl)
• Patient education
• TREAT ALL SEXUAL CONTACTS

83. Slide 83
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Sexually Transmitted Diseases
• Candidiasis
 Etiology/pathophysiology
• C. albicans and C. tropicalis
 Clinical manifestations/assessment
• Mouth: Edema; white patches
• Nails: Edematous, darkened, erythematous nail base;
purulent exudate
• Vaginal: Cheesy, tenacious white discharge; pruritus;
inflammation of the vagina
• Penis: Purulent exudate
• Systemic: Chills; fever; general malaise

84. Slide 84
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Sexually Transmitted Diseases
• Candidiasis (continued)
 Medical management/nursing interventions
• Pharmacological management
 Nystatin (Mycostatin)
 Topical amphotericin B
• Treat underlying condition

85. Slide 85
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Sexually Transmitted Diseases
• Chlamydia
 Etiology/pathophysiology
• Chlamydia trachomatis
 Clinical manifestations/assessment
• Usually asymptomatic
• Male
 Scanty white or clear exudate
 Burning or pruritus
 Urinary frequency; mild dysuria

86. Slide 86
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Sexually Transmitted Diseases
• Chlamydia (continued)
 Clinical manifestations/assessment
• Female
 Vaginal pruritus or burning
 Dull pelvic pain
 Low-grade fever
 Vaginal discharge; irregular bleeding
 Medical management/nursing interventions
• Pharmacological management
 Tetracycline; doxycycline; Zithromax
• TREAT ALL SEXUAL CONTACTS

87. Slide 87
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Nursing Process
• Nursing diagnoses
 Anxiety
 Body image, disturbed
 Coping, ineffective
 Fear
 Fluid volume, deficient
 Health maintenance,
ineffective
 Infection, risk for
 Knowledge, deficient
 Pain, acute and
chronic
 Self-esteem,
situational low
 Sexual dysfunction
 Skin integrity, impaired
 Tissue perfusion,
ineffective
 Urinary elimination,
impaired

88. Sex Hormones
 Production influenced by the anterior pituitary
 Male: testosterone; androgens
 Female: estrogen; progesterone
88
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89. Androgens
Actions
 Development of secondary sex characteristics; tissue
building
Uses
 Hypogonadism, hypopituitarism, dwarfism, eunuchism,
cryptorchidism, oligospermia, and male androgen
deficiency
Adverse Reactions
 Edema due to sodium retention, acne, hirsutism, male
pattern baldness, cholestatic hepatitis with jaundice,
buccal irritation, nausea and vomiting, diarrhea
89
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90. Androgens (cont.)
Drug Interactions
 Increased effects – anticoagulants, antidiabetic agents,
and other drugs
 Decreased effects – barbiturates
 Concurrent use with corticosteroids increase edema
Nursing Implications
 Assessment, diagnosis, planning, implementation, and
evaluation
Drug Table 21-9
90
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91. Androgens (cont.)
Patient and Family Teaching
 Administration
 Response time
 Diet
 Symptoms to report
 Administration considerations
91
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92. Female Sex Hormones
 Estrogens
 Progestins
 Table 21-10
92
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93. Estrogens
Action and Uses
 Used for hormone replacement therapy in menopause
and other conditions (ovarian failure); infertility work-
ups; palliative breast cancer treatment
Adverse Reactions
Drug Interactions
93
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94. Progestins
Action
Uses
 Contraception, control excessive uterine bleeding,
treatment of secondary amenorrhea, dysmenorrhea,
premenstrual tension, and control of pain in
endometriosis
Drug Interactions
Nursing Implications and Patient Teaching
94
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95. Oral Contraceptives
Combination Drugs: Estrogen and Progestin
 Table 21-11
Action
 Prevent ovulation
Use
 Contraception
Adverse Reactions
 Estrogen excess, progestin excess, androgen excess,
estrogen deficiency, progestin deficiency
Contraindications for Oral Contraceptives
95
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