Chapter 47: Assessing the Reproductive System

*Purposes: produce hormones, sexual pleasure, reproduction

Male Reproductive System
Paired testes, scrotum, ducts, glands, penis, breasts
Sperm production
o Seminiferous tubules, efferent ducts, retis testes, epididymis, vas deferens, ampulla
Seminal fluid
o Production
o Nourishes sperm
o Provides bulk
o Increases alkalinity
o Mixes with sperm at ejaculatory duct
Prostate Gland: encircles the urethra, just below the urinary bladder
Spermatogenesis
o Ongoing process from puberty to death
o Stored in Sertolis cells
o Events of spermatogenesis
Androgens
o Most produced in the testes
o Small amount produced in the adrenal cortex
o Testosterone
Development/maintenance of sexual organs
Secondary sex characteristics
Spermatogenesis
Promotes metabolism
Promotes growth of muscles and bone
Supports libido
Health History
o Family history of testicular or prostate cancer
o Chronic diseases
o Medication use
o Did mother take diethylstilbestrol during pregnancy?
o Did client have mumps as a child?
o Lifestyle
o Questions about sexuality
Benign prostatic hyperplasia
Changes in seminal vesicles
Penile changes
Impotence
Manifestations of Impairment
o Breast
Gynecomastiaabnormal enlargement of the breasts in men
Hard, irregular nodule in nipple areasuggests a carcinoma
Enlarged axillary nodesmay be caused by cancer
Enlarged supraclavicular nodesmay indicate metastasis
Groin: bulge in inguinal/ femoral areaif it increases with coughing or straining it may
suggest a hernia
o Penis
Phimosistightness of prepuce that prevents retraction of foreskin
Paraphimosisretraction of the foreskin that causes painful swelling of the glans

Balanitisinflammation of the glans, associated with bacterial and fungal infections

Ulcers, vesicles, or wartssuggest an STI
Nodules/sores on penisseen in uncircumcised men may indicate cancer
Urinary meatus erythema or dischargeinflammatory disease
Excoriation or inflammation of penile skinsuggests lice or scabies
Induration with tenderness along the ventral surfacesuggests urethral stricture with
inflammation
o Scrotum
Unilateral/ bilateral poorly developed scrotumsuggests cryptorchidism (failure of one
or both testes to descend into the scrotum)
Swelling of the scrotummay indicate indirect inguinal hernia, hydrocele, or scrotal
edema
Tender, painful scrotal swellingoccurs in acute epididymitis, acute orchitis, torsion of
the spermatic cord, and strangulated hernia
A painless testicular noduleassociated with testicular cancer
o Prostate
Enlargement and obliteration of median sulcus
Enlargement with asymmetry/tenderness
Hard irregular nodule
Age-Related changes
o BPH incidence increases with age
o Epithelial tissue and mucosa of seminal vesicles are thinner and have reduced capacity to hold
fluid
o Reduced sperm count
o Sclerosis of penile arteries and veinstakes longer to achieve an erection and ejaculation, or
possible impotence
Diagnostic Tests of the Male Reproductive System
Test
Purpose & Description
Nursing Interventions
Biopsy of the prostate
Determine the cause of an elevated Done transrectally, pt. may need
PSA and to diagnose cancer
enema before procedure, general
anesthesia is usedNPO 8-12
hours before test, avoid strenuous
activity for 4 hours after testing,
may be some blood in the urine or
stool after testing and semen may
appear dark
Prostate specific antigen (PSA)
Blood tests used to screen for
Inform that transient increases in
prostate cancer, normal value is 0PSA occur following prostate
4.0 ng/mL
palpation or rectal exams, so these
should not be scheduled for 3 days
before the test is done
Prostate ultrasound
To identify testicular torsion or
Tell pt. to administer a Fleeds
masses, to evaluate prostate
enema and hour before the test, ask
enlargement
them to void prior
Semen analysis
Assess volume, motility, and sperm Pt. is asked to bring in a fresh
count, and % of abnormal sperm
specimen within 2 hours of
Normal values are: volume 2-5 mL, ejaculation
sperm count >20 million/mL, 60%
motile, and 60% normal sperm
Female Reproductive System

External Genitalia or Vulva

o Mons pubis
o Labia
o Clitoris
o Vaginal and urethral openings
o Glands
Internal Organs
o Cervix
o Uterus
o Fallopian tubes
o Ovaries
Breasts
Development of Ovum
o Follicles stimulated
Follicle-stimulating hormone (FSH)
Luteninzing hormone (LH)
o Ovulation
Ovarian Cycle
o Three phases that occur cyclically
Follicular phase
Ovulatory phase
Luteal phase
Menstrual Cycle
o Menstrual phase
o Proliferative phase
o Secretory phase
Ovaries
o Cyclic pattern
Estrogens
Progesterone
Androgens
Estrogens
o 3 forms: Estrone E1, Estradiol E2, Estriol E3
o Essential for secondary sex characteristics
o Helps prepare for growth of a fetus
o Supports skin and blood vessels
o Decreases rate of bone reabsorption
o Promotes increased high-density lipoproteins
o Reduces cholesterol levels
o Enhances blood clotting
Progesterone: development of breast glandular tissue, endometrium
Androgens: responsible for hair growth patterns at puberty
Health History
o Family history of ovarian or breast cancer
o Menstrual history
o Obstetric history
o Sexual history
o Medication use
o Reproductive system examination history
o Chronic illnesses
o History of diethylstilbestrol exposure in utero

o Exposure to asbestos
o Exposure to cigarette smoke
o History of fibrocystic disease
o History of vaginal bleeding and vaginal discharge
o Questions about sexuality
Manifestations of Impairment
o Breast
Retractions, dimpling, abnormal contourssuggests lesions
Peau dorange/unilateral venous patternsthickened dimpled skin with enlarged pores,
associated with malignancy
Redness infection or carcinoma
Recent unilateral inversion of nipple or asymmetry in direction in which nipples point
suggests cancer
Tenderness upon breast palpationpremenstrual fullness, fibrocystic disease, or
inflammation
Nodules in tail of breastenlarged lymph nodes
Hard, irregular, poorly delineated, fixed unilateral massessuggest carcinoma
Bilateral, single or multiple, round, mobile, well-delineated massesconsistent with
fibrocystic breast disease or fibroadenoma
Swelling, tenderness, erythema, and heatmastitis
Loss of nipple elasticitycancer
Blood or serous dischargeassociated with intraductal papilloma
Bilateral milky discharge not due to prior pregnancypituitary tumor
Unilateral discharge from one or two ductsfibrocystic breast disease, intraductal
papilloma, or carcinoma
Rashallergy or other causes
Signs of inflammation and infectionsinfection of the sweat glands
Enlarged axillary nodesinfection of the hand or arm, but can be caused by a
malignancy
Enlarge supraclavicular nodeslymphatic metastasis
o External Genitalia
Excoriation, rashes or lesions of labiainflammatory or infective processes
Bulging of labia that increases with strainingsuggests a hernia
Varicosities
Ulcers or vesicles on labiaSTIs
Small, firm, round cystic nodules in labiasebaceous cysts
Wart-like lesionssuggests genital warts
Firm, painless ulcerssuggest chancre of syphilis
Shallow, painful ulcerssuggests herpes infection
Ulcerated or red raised lesions in older womensuggest vulvar carcinoma
Enlargement of the clitorissymptoms of masculinizing condition
Swelling, discoloration, or lacerations of vaginal openingtrauma
Discharge from or lesions on vaginal openingsymptoms of infection
Fissures or fistulas associated with vaginal openinginjury, infection, growth of a
malignancy, or trauma
Discharge/tenderness of Skenes glandsinfection
**A non-tender mass in posterolateral labia majoraBartholins cyst**
Swelling, redness, or tendernessabscess of Bartholins glands
Bulging of the anterior and/or posterior vaginal wallcystocele & rectocele
Protrusion of the cervix or uterus into vaginauterine prolapse
Inflammation, lesions, growths on perineuminfections or cancer
o Vagina and Cervix

Bluish color of cervix/vaginal mucosasign of pregnancy

Pale cervixanemia
Cervix to the right or left of midlinemay indicate a pelvic mass, uterine adhesions, or
pregnancy
Projection of cervix more than 3 cm into vaginal canalmay indicate a pelvic or uterine
mass
Transverse or star-shaped cervical lacerationsreflect trauma causing tearing of the
cervix
Enlarged cervixinfection
Small, white, or yellow raised, round areas on cervixNabothian cysts are considered
normal, but may become infected
Cervical polyps
Retroverted uterus
Retroflexed uterus
Pain on movement of the cervixPID
Myomas
Ovarian tumors
Profuse menstrual bleedingendometrial polyps, dysfunctional uterine bleeding, and use
of an IUD
Irregular bleedingendometrial polyps, DUB, uterine or cervical carcinoma, or oral
contraceptives
Postmenopausal bleedingendometrial hyperplasia, estrogen therapy, and endometrial
cancer
Use of the Vaginal Speculum
o Graves speculum is used most often for exams of adult women
o Pederson speculum is narrower and is used for adolescents or adult women who are virgins, or
have never had a baby
o If cultures or smears are to be obtained, water and gel should not be used to warm or lubricate
the speculum
Age-Related changes
o Atrophy and sagging of breast tissue and linear strands may appear from shrinkage and fibrotic
changesmakes finding tumors more difficult
o Labia flatten, vulvar adipose tissue and hair decreases
o Decreased collagen and adipose tissue in the vaginal canal, loss of rugae, shortening and
narrowing of the vaginal canalvagina is more easily irritated increasing risk for vaginal
infections
o Decreased vaginal lubrication, epithelium becomes thinner and avascular
o More alkaline pH of vagina
o Cervix becomes smaller
o Uterus shrinks
o Fallopian tubes shrink and shorten
o Ovaries are smaller and thicker
o Menopause: decreased production of estrogenpelvic floor muscle weakness, wrinkling, and
growth of facial hair
Diagnostic Tests of the Female Reproductive System
Test
Purpose & Description
Nursing Interventions
Breast Biopsy
Fine-needle aspiration to withdraw Local anesthetic is used, no stitches
fluid from cysts, core needle is
are required for a fine-needle
done to obtain a sample of tissue
aspiration, core needle biopsy, or
from a solid mass
mammotome
For all typeswearing a bra,

Breast cancer genetic testing

(BRAC-1, BRAC-2)
Breast ultrasound

Chlamydia screening

Colonoscopy

Endometrial biopsy

HPV test

Hysterosalpingogram

Mammogram
Pap smear

Ultrasound

Blood test to identify a

predisposition to breast and ovarian
cancers
Detect masses in the breasts

Swab of cells is take form the

infected area, cultures may also be
taken from the throat and rectum
Done if a Pap test detects cell
changes, visualizes the cervix and
acetic acid is applied to the
cervixabnormal cells will turn
white

applying ice packs, and mild

analgesics decrease discomfort
post-procedure
Suggest genetic counseling
regardless of testing outcomes
Tell woman not to apply ointment,
body powder, or underarm
deodorant before the test
Withhold antibiotics and douching
before the testing

Abstain from douching and

intercourse for 48 hours prior,
slight vaginal bleeding may occur
post-procedure, abstain from
vaginal intercourse 1-2 days after,
and take NSAIDs for discomfort or
cramping
To identify endometrial hyperplasia Procedure is briefly painful, may
or endometrial cancer
cause vaginal bleeding, use
perineal pads and avoid tampon use
and sexual intercourse while
bleeding
Screening in women after age 30 in Done when women is not
conjunction with a Pap smear to
menstruating, should not douche,
test for the HPV virus
use tampons, use any vaginal meds
for at least 48 hours prior to exam;
void prior to exam, small amount
of vaginal bleeding or gray-green
discharge may occur, no
intercourse until the HCP says its
safe to do so
To diagnose causes of infertility
Contraindications include
and abnormalities of the uterus of
pregnancy, vaginal bleeding, and
fallopian tubes; test should be done acute infections; assess for allergy
on the 7-9th day after the end of the to seafood/iodine, bloody discharge
menstrual period
for 3-4 days after test
Detects tumors in the breasts
Contraindicated during pregnancy
To diagnose malignant and
Done when not menstruating,
premalignant lesions of the cervix
instruct to not have intercourse, use
vagina meds, or douche for 24-48
hours after test
Detects the presence of spaceInstruct pt. to increase intake of
occupying lesions
fluids, not to void until the test is
done to ensure a full bladder