Reproductive SystemReproductive System

Amy McDonald MSN, RNAmy McDonald MSN, RN

Female External OrgansFemale External Organs

Female Internal OrgansFemale Internal Organs

Female Reproductive Female Reproductive HormonesHormones

Male Reproductive System Male Reproductive System

Menstruation and Menstruation and MenopauseMenopause• MenarcheMenarche

• MensesMenses

• MenopauseMenopause

• ClimactericClimacteric

• Biological changes with menopauseBiological changes with menopause

• Artificial menopauseArtificial menopause

• ““hot flashes” – lack of estrogen, inc. other hot flashes” – lack of estrogen, inc. other hormones, = surge & dilation of bld vesselshormones, = surge & dilation of bld vessels

HRTHRT

• RisksRisks• BenefitsBenefits• ContraindicationsContraindications

– Estrogen dependent cancerEstrogen dependent cancer– Undx abnormal vaginal bldUndx abnormal vaginal bld– DVTDVT– Liver diseaseLiver disease– Hx breast caHx breast ca– Heart diseaseHeart disease

Male MenopauseMale Menopause

Testosterone polypeptide Testosterone polypeptide structure vs. HCG polypeptide structure vs. HCG polypeptide structurestructure• Testosterone Testosterone • HCGHCG

Pap SmearPap Smear

• No sexual intercourse for at least 24 No sexual intercourse for at least 24 hours before testhours before test

ColposcopyColposcopy

LaparoscopyLaparoscopy

Laparoscopy vs. Laparoscopy vs. Laparotomy Laparotomy

HysteroscopyHysteroscopy

Cervical ExamCervical Exam

MammogramMammogram

Breast BiopsyBreast Biopsy

Needle Biopsy of ProstateNeedle Biopsy of Prostate

Who’s at Risk?Who’s at Risk?

•Just about Just about all of usall of us

SyphilisSyphilis

• Primary- chancre, painless, weepingPrimary- chancre, painless, weeping

• Secondary- 6 wks to 6 mo. Flu-like sxSecondary- 6 wks to 6 mo. Flu-like sx

• Latency- shows on bld test? MaybeLatency- shows on bld test? Maybe

• Tertiary- CNS involvement, balance, Tertiary- CNS involvement, balance, gaitgait

• VDRLVDRL

• PCNPCN

SyphilisSyphilis

SyphilisSyphilis

SyphilisSyphilis

SyphilisSyphilis

Secondary SyphilisSecondary Syphilis

Congenital SyphilisCongenital Syphilis

GonorrheaGonorrhea

• ““the clap”the clap”

• Urethral culture Urethral culture

• Gram stain (immediate but not as Gram stain (immediate but not as accurate, usually id’s bacteria causing clapaccurate, usually id’s bacteria causing clap

• Tx with antibioticsTx with antibiotics

• Women- can lead to infertilityWomen- can lead to infertility

• Men- can lead to infertility (epididymitis) Men- can lead to infertility (epididymitis)

• Sexual partners need to be treated!!!Sexual partners need to be treated!!!

HerpesHerpes

• No cureNo cure

• #1 nsg dx ~ pain#1 nsg dx ~ pain

Genital WartsGenital Warts

• StronglyStrongly assoc. with dysplasia and assoc. with dysplasia and cervical cancercervical cancer

• May be “silent” for womenMay be “silent” for women

HPVHPV

HPVHPV

HPVHPV

HPVHPV

Vaginitis Vaginitis

• What’s the number one nursing dx? What’s the number one nursing dx?

Trichomonas VaginalisTrichomonas Vaginalis

• Treat sexual partnersTreat sexual partners

• No alcohol Flagyl (severe N/V, liver No alcohol Flagyl (severe N/V, liver damage)damage)

Pelvic Inflammatory DiseasePelvic Inflammatory Disease

• Can cause sterility by scarring enough Can cause sterility by scarring enough to permanently block fallopian tubesto permanently block fallopian tubes

• Lower abd painLower abd pain

• Vaginal d/cVaginal d/c

• Abnormal vaginal bldAbnormal vaginal bld

• DysuriaDysuria

• Intrauterine devices contraindicatedIntrauterine devices contraindicated

Intrauterine Devices (IUD)Intrauterine Devices (IUD)

• Progesterone thickens mucous of Progesterone thickens mucous of cervixcervix

Toxic Shock SyndromeToxic Shock Syndrome

• UncommonUncommon

• Assoc with use of tamponsAssoc with use of tampons

• Wash hands before insertion of Wash hands before insertion of tampons tampons

BartholinitisBartholinitis

• What is the function of the Bartholin What is the function of the Bartholin glands?glands?

Uterine FibroidsUterine Fibroids

• MenorrhagiaMenorrhagia

More FibroidsMore Fibroids

Uterine ProlapseUterine Prolapse

EndometriosisEndometriosis

• Can result in infertility Can result in infertility

• Danazol ~ side effects ~ hot flashesDanazol ~ side effects ~ hot flashes

Cystocele Cystocele

RectoceleRectocele

Vaginal FistulaVaginal Fistula

• Leakage of urine, flatulence, or feces Leakage of urine, flatulence, or feces into vagina into vagina

Ectopic PregnancyEctopic Pregnancy

Abdominal PregnancyAbdominal Pregnancy

Tubal LigationTubal Ligation

Tubal LigationTubal Ligation

HysterectomyHysterectomy

• When would an abdominal When would an abdominal hysterectomy be needed?hysterectomy be needed?

OrchitisOrchitis

• Complication of mumps if not Complication of mumps if not vaccinatedvaccinated

HydroceleHydrocele

HydroceleHydrocele

Hydrocele TransilluminationHydrocele Transillumination

Orchitis Transillumination Orchitis Transillumination

““Don’t let it get this bad” Don’t let it get this bad” HydroceleHydrocele

““Definitely don’t let it get this Definitely don’t let it get this bad” Hydrocelebad” Hydrocele

VaricoceleVaricocele

VaricoceleVaricocele

Testicular TorsionTesticular Torsion

PhimosisPhimosis

Epididymitis Epididymitis

EDED

• Men who take Viagra should NOT Men who take Viagra should NOT take Nitroglycerin~ can cause a take Nitroglycerin~ can cause a sudden decrease in BPsudden decrease in BP

BPHBPH

• Enlargement of tissue of prostate Enlargement of tissue of prostate causing compression on the urethra causing compression on the urethra and thus urinary retentionand thus urinary retention

TURPTURP

PerinealPerineal

Suprapubic CatheterSuprapubic Catheter

ProstatectomyProstatectomy

• Will have catheter at least one day Will have catheter at least one day regardless of type of surgery regardless of type of surgery

• Avoid caffeine and spicy foodsAvoid caffeine and spicy foods

VasectomyVasectomy

• Is sperm production or transport Is sperm production or transport disrupted? disrupted?

VasectomyVasectomy

Fibroadenoma vs. Fibrocystic Fibroadenoma vs. Fibrocystic Breast DiseaseBreast Disease

Breast DisordersBreast Disorders

• Keep in mind that 90% of lumps are Keep in mind that 90% of lumps are benignbenign

• #1 nsg dx- anxiety r/t potential #1 nsg dx- anxiety r/t potential malignancymalignancy

Oral ContraceptivesOral Contraceptives

• Inhibits endometrial developmentInhibits endometrial development

• ProsPros– 90-95% effective90-95% effective– Few serious short-term side effectsFew serious short-term side effects

• ConsCons– Back up method needed if taken lateBack up method needed if taken late– Ectopic pregnancies and ovarian cystsEctopic pregnancies and ovarian cysts

Side effects of BCPSide effects of BCP

• Estrogen- nausea, breast tenderness, Estrogen- nausea, breast tenderness, headacheheadache

• Progesterone- acne, weight gain, oily Progesterone- acne, weight gain, oily skinskin

• Both- no menses, mood changesBoth- no menses, mood changes

TeachingTeaching

• Antibiotics decrease effectiveness Antibiotics decrease effectiveness • > 35, smoke, bld clots, breast > 35, smoke, bld clots, breast

endometrial cancerendometrial cancer• Missed pill = 1-2 pills immediately, Missed pill = 1-2 pills immediately,

backup 7 daysbackup 7 days• 3 pills missed- start over after 3 pills missed- start over after

menses, use backupmenses, use backup• Contact healthcare provider if ACHESContact healthcare provider if ACHES

ACHESACHES

• A- abdominal pain, problem with GB A- abdominal pain, problem with GB or liveror liver

• C- chest pain, shortness of breathC- chest pain, shortness of breath

• H- headachesH- headaches

• E- eye problemsE- eye problems

• S- severe leg painS- severe leg pain

Ortho Evra Ortho Evra

• ProsPros– ConvenientConvenient– 99% effective99% effective

• ConsCons– Less effective > 198 lbs.Less effective > 198 lbs.– Risk of bld clot, heart attack, strokeRisk of bld clot, heart attack, stroke– Exposure to 60% more estrogenExposure to 60% more estrogen

NuvaringNuvaring

• ProsPros– 99.7% effective99.7% effective

• Cons Cons – Side effects same as pill, patchSide effects same as pill, patch

• ContraindicationsContraindications– Vaginal irritation, ulcerationVaginal irritation, ulceration

Depo ProveraDepo Provera

• ProsPros– 99.7% effective99.7% effective

• ConsCons– 4 lbs wt gain per year4 lbs wt gain per year– High risk bone loss, contributing to High risk bone loss, contributing to

osteoporosis osteoporosis

IUDIUD

• Progestasert- good for one yearProgestasert- good for one year– Not as effective as MirenaNot as effective as Mirena

• Mirena- good for 5 yearsMirena- good for 5 years

IUD Pros and ConsIUD Pros and Cons

• ProsPros– 98-99% effective98-99% effective– ConvenientConvenient

• ConsCons– Must have given birthMust have given birth– Incr. risk PID, uterine perforation, Incr. risk PID, uterine perforation,

abnormal bleeding, ectopic pregnancy abnormal bleeding, ectopic pregnancy

IUD ContraindicationsIUD Contraindications

• Pelvic diseasePelvic disease

• Abnormal bleedingAbnormal bleeding

• Abnormally shaped uterusAbnormally shaped uterus

ParagardParagard

• Pros Pros – 99% effective99% effective– ConvenientConvenient– No hormones usedNo hormones used

• ConsCons– Longer, heavier periodsLonger, heavier periods– $450 $450

DiaphragmDiaphragm

• ProsPros– 80-94% effective80-94% effective– No hormonesNo hormones– May help with STDs and PIDMay help with STDs and PID

• ConsCons– Custom fitCustom fit– Interrupted relationsInterrupted relations– Incr. risk UTIsIncr. risk UTIs

DiaphragmDiaphragm

Cervical CapCervical Cap

• Pros Pros – 84-91% effective (never given birth)84-91% effective (never given birth)– Good for 48 hoursGood for 48 hours

• ConsCons– 68-74% effective (given birth)68-74% effective (given birth)– Cervical ulcersCervical ulcers– FittedFitted– Good manual dexterityGood manual dexterity

Cervical CapCervical Cap

SpongeSponge

• ProsPros– OTCOTC– Good for 24 hrsGood for 24 hrs– Hormone freeHormone free– InexpensiveInexpensive

• ConsCons– 84% effective with typical use84% effective with typical use– 91% effective with proper use91% effective with proper use– Can slip out of place during sexCan slip out of place during sex

SpongeSponge

Female CondomFemale Condom

• Helps protect against STDsHelps protect against STDs

• OTCOTC

• 79-95% more effective79-95% more effective

• More sensation for male than regular More sensation for male than regular condomcondom

Female CondomFemale Condom

Male CondomMale Condom

• Helps protect against STDsHelps protect against STDs

• 64-98% effective64-98% effective

SpermicidesSpermicides

• Chemical action kills spermChemical action kills sperm

• OTCOTC

• Good for one hourGood for one hour

• inexpensiveinexpensive

Natural Family PlanningNatural Family Planning

• 80% effective80% effective

• Calendar methodCalendar method

• Measure basal body tempMeasure basal body temp

• Predictor tests for ovulationPredictor tests for ovulation

Non-Surgical SterilizationNon-Surgical Sterilization

• Essure Permanent Birth Control Essure Permanent Birth Control SystemSystem

• Takes about 3 monthsTakes about 3 months

Emergency ContraceptionEmergency Contraception

• ““morning after pill”morning after pill”

• ControversialControversial

• 75-89% effective75-89% effective

• Inhibits fertilizationInhibits fertilization