NCM 109 – LEC wk5

Nursing Care of Male and Female Clients with General and Specific Problems in
Reproduction and Sexuality

PART 1 REVIEW OF THE ANATOMY:

- Sexual Identity
o A multi-dimensional phenomenon: physical, emotional social and
intellectual.
o Biologic Gender- chromosomal sexual development:
 Male (XY) Female (XX)
o Gender Identity- the inner sense a person has of being male or female.
o Gender Role- the behavior a person conveys about being male or female.
 It may not be the same of biologic gender or gender identity.
- Reproductive Development
o Physiologic preparation begins during Intrauterine life.
o Sex is determined at conception: Chromosome Formation
 5th week: development of primitive gonadal tissues: 2
undifferentiated ducts:
 Mesonephric
 Paramesonephric
 7th-8thweek: differentiation into primitive testes
o 10th week: dev't of mesonephric ducts if testosterone is present;
 If not paramesonephric--> female genitalia.
o 12th week:visibility of penile tissue elongated(male); urogenital folds
(female); scrotal tissue vs. labia majora.
o OOCYTES formation (2M at birth)
- AMBIGUOUS (not clear) GENITALIA
o Increased androgen production in newborn girls (results in ambiguous
genitalia) in newborn girls
o Pubertal Development
 Adrenal androgens and sex hormones maintains development of
sex characteristics (low until puberty)
 PUBERTY: Hypothalamus stimulated to release: GnRf/ GnRh.
 Anterior pituitary: FSH, LH
 Gonads:
 Testes: testosterone, androgen
 Ovaries: estrogen, progesterone
o The Role of Androgen
  Muscular development, physical growth
 Increase in sebaceous gland secretions.
 Dev't of testes,scrotum, penis, prostate, seminal vesicles.
 Male pubic, axillary and facial hair
 Laryngeal enlargement.
 Maturation of spermatozoa
 Closure of growth in long bones
 In Females: Adrenarche.
 Estrogen is secreted at high levels from ovarian follicles at puberty.
 3 compounds but 1 mechanism of action:
 Estrone (E1), Estradiol (E2), Estriol (E3)
 Influences:
 Maturation and maintenance of secondary sex
characteristics (e.g Breast development.
 Closure to epiphyseal plates of long bones (prevent
Osteoporosis)
 Limits the effects of atherosclerosis.

- Human Sexual Response

- 4 Stages: EPOR
o Excitement
 sensual stimulation by both physical (sight, sound, touch, smell)
and psychological (thought, emotion).
  Sympathetic stimulation: arterial dilatation and venous constriction
in the genitals
o Plateau
 just before orgasm.
o Orgasm
 discharge of accumulated sexual tension
o Resolution
 the return to unaroused state.
- Types of Sexual Orientation
o Heterosexuality - romantic attraction, sexual attraction or sexual behavior
between persons of the opposite sex or gender
o Homosexuality - sexually attracted to people of one's own sex
o Bisexuality
o Transsexuality
- Types of Sexual Expression
o Celibacy
 Abstinence from sexual activity. The avowed state of certain
 religious orders or personal choice.
 Advantage: Able to concentrate on means of giving and receiving
love other than through sexual expression.
o Masturbation
 Self- stimulation for erotic pleasure or release of overall tension and
anxiety.
 Children ages 2-6 y/o (Pre-School) up to school age does. –
curiousity.
 A nurse counsels parents on what is expected.
o Erotic Stimulation
 The use of visual materials such as magazines or photographs for
sexual arousal.
 This is a normal one and marks a developmental milestone among
adolescents.
o Fetishism
 Use of certain objects (such as leather, rubber, shoes, and feet) or
situations as focus of arousal.
o Transvestism
 Dressing like that of the opposite sex.
 A transvestite could be heterosexual, homosexual or bisexual.
o Voyeurism
 Sexual arousal by looking at another’s body. (e.g. watching R-
movies)
 Reflects great insecurity or inability to feel confident enough to
relate to others on a personal level.
o Sadomasochism
 In order to achieve Sexual Satisfaction.
 Sadism- inflicting pain
 Masochism- receiving pain
 Autoerotic asphyxia – hanging during masturbation to
produce sexual excitement. (fatal)
 Health Education on adolescents.
o Others:
 Exhibitionism - revealing one’s genitals in public.
 Pedophilia - sexual interest in children.
 Obscene phone calling - phonesex
 Bestiality

PART 2
- Infertility
o The inability to conceive a child or sustain a pregnancy to childbirth.
o Affects 10-15% of couples who desire children
o Cause fear and anxiety over the inadequacies
o Exist when a pregnancy has not occurred at least 1 year of engaging in
unprotected coitus.
o 2 TYPES
 Primary Infertility – no previous conception.
 Secondary Infertility – has previous viable pregnancy but unable to
conceive at present.
o Infertility Assessment
 Requires series of laboratory and physical exams.
 This may affect self-esteem and self-image.
 Actions
 Talk each of the couple privately.
o Nursing Diagnosis
 Fear related to outcome of infertility studies.
 Anxiety /t heavy schedule and timing of planned testing.
 Deficient knowledge rt measures to promote fertility.
 Sexual Dysfunction
 Powerlessness
 Hopelessness
o Planning
 Testing takes a long time, results will not be instantaneous.
  Couple may need to modify or change their goals of tests.
o Implementation
 Fertility testing can be costly.
 Couple must know budget/amount of tests.
 Needs
 Thorough education about tests
 Results reaction may vary from stoic to acceptance, grief
and separation
o Multifactoral causes
 Male
 Inadequate sperm count / Disturbance in spermatogenesis.
 Normal Sperm count:
o 20 million/ml of seminal fluid or 50 million per
ejaculation.
 Healthy sperm
o 60 % motile
o Normal in shape and form
o Temperature slightly lower than body temp
o Actions that increase scrotal heat:
 desk job
 driving
 frequent use of sauna
 Causes
o Chronic Infection. (TB)
o Congenital abnormalities:
 Cryptorchidism
 Sons of women who took DES
(diethylstilbestrol)
 Varicocele - may increase temperature.
o Obstruction
 (seminiferous tubules, ducts or vessels
preventing movement of spermatozoa)
 Paths: seminiferous tubules, epididymis, vas
deferens, ejaculatory duct, and urethra
o Other causes:
 Vasectomies
 Obstruction of vas deferens .
 Anomalies of the Penis
 Hypospadias
  Epispadias
 Diseases:
o *Mumps orchitis.
o *Epididymitis
o *Tubal infections:
 Gonorrhea
 Urethral infection.
 Infections of prostate glands, seminal vesicles
 Ejaculation problems
o Causes:
 Psychological problems
 Debilitating diseases: CVA or Parkinson’s
disease
 Medications: Antihypertensive drugs.
o These results in erectile dysfunction
 2 types:
 Primary- never achieve erection
 Secondary- able to achieve ejaculation
in the past but has a problem now.
o Female Infertility factors
 Anovulation
 Absence of ovulation
 Most common cause of infertility in women.
 Causes:
o Genetic (Hypogonadism) – no ovaries to produce ova.
o Hormonal imbalance - Hypothyroidism- interferes with
hypothalamus-pituitary- ovarian interaction.
o Chronic or excessive exposure to x-rays or
radioactive substances.
o General ill health
o Poor diet
o Stress- affects ovaries by reducing hypothalamic
stimulation.
 Tubal Transport problems
 Usually caused by either pelvic infection, such as pelvic
inflammatory disease (PID) or pelvic endometriosis.
 Sometimes it can be caused by scar tissue that forms after
pelvic surgery.
 Tubal Problem
 o The rate of ectopic pregnancy in women with previous
known PID is increased 6-10 times higher than in
women with no previous history of PID.
 Uterine problems
 A uterine disease, the first sign may be bleeding between
periods or after sex.
 Causes of abnormal bleeding include hormones, thyroid
problems, fibroids, polyps, cancer, infection or pregnancy.
o Testing for Tubal Infertility/Diagnostics
 Hysterosalpingogram
 Dye is injected from cervix to uterus and exit to abdominal
cavity.
 Laparoscopy
 a surgical diagnostic procedure used to examine the organs
inside the abdomen
 With the use of tubal catheterization
 Treatment for Tubal factor infertility
 Tubal surgery
 IVF
o Fibroid tumor
 These are noncancerous growths (tumors) in the uterus.
 In most cases, treatment is not needed at all.
 Treatment is only considered if the fibroid is growing rapidly.
 S/Sx Fibroid tumor need to attend. (signs and symptoms)
 Abdominal enlargement
 Abdominal pain
 Excessive vaginal bleeding
 Pelvic pressure
 Pain with intercourse
 Medications
 GnRH agonists such as leuprolide.
o (Lupron – shrink fibroids_
o It is used only to help decrease bleeding as a woman
prepares for surgery.
 Birth control pills can also decrease bleeding caused by
fibroids.
 NSAIDS –treat pain and decrease amount of menstrual
bleeding.
 Surgical Treatments: Myomectomy
  It can be done through an incision in the abdomen
(abdominal myomectomy), or through the vagina without an
incision.
 Hysterectomy: partial or complete removal of the uterus.

PART 3 REPRODUCTIVE DISORDERS

- Women with Reproductive Disorders -- Menstrual Disorders

o Dysfunctional Menstrual Cycles
 Dysfunctional uterine bleeding (DUB) is defined as abnormal
uterine bleeding in the absence of organic disease.
 It usually presents as heavy menstrual bleeding (menorrhagia).
 Diagnostic Tests
 Abdominal examination
 Pelvic examination
 Cervical smear
 Infection screening
 Treatment
 First line: Levonorgestrel-releasing intrauterine system
provided long-term use (at least 12 months) is anticipated.
 Surgical management
 Endometrial ablation
 Hysterectomy
o Amenorrhea
 Amenorrhea is a menstrual condition characterized by absent
menstrual periods for more than three monthly menstrual cycles.
 Amenorrhea may be classified as primary or secondary.
 Treatments:
 Progesterone supplements (hormone treatment)
 Oral contraceptives (ovulation inhibitors)
 Dietary modifications
o Dysmenorrhea
 Dysmenorrhea is a menstrual condition characterized by severe
and frequent menstrual cramps and pain associated with
menstruation.
 Dysmenorrhea may be classified as primary or secondary.
 Primary dysmenorrhea - from the beginning and usually
lifelong; severe and frequent menstrual cramping caused by
severe and abnormal uterine contractions.
 Secondary dysmenorrhea - due to some physical cause and
usually of later onset; painful menstrual periods caused by
another medical condition present in the body (i.e., pelvic
inflammatory disease, endometriosis).
o Primary dysmenorrhea refers to recurrent pain,
o secondary dysmenorrhea results from reproductive
system disorders
 Signs and Symptoms
 Cramping in the lower abdomen
 Pain in the lower abdomen
 Low back pain
 Pain radiating down the legs
 Nausea
 Vomiting
 Diarrhea
 Fatigue
 Weakness
 Fainting
 Headaches
 DIAGNOSTIC TESTS
 Ultrasound (sonography.)
 Magnetic resonance imaging (MRI)
 Laparoscopy
 Hysteroscopy
 Treatment
 Prostaglandin inhibitors (i.e Nonsteroidal anti-inflammatory
medications, or NSAIDS, such as aspirin, ibuprofen) - to
reduce pain.
 Acetaminophen
 Oral contraceptives (ovulation
 Progesterone (hormone treatment)
 Dietary modifications (to increase protein and decrease
sugar and caffeine intake)
 Vitamin supplements
 Regular exercise
 Heating pad across the abdomen
 Hot bath or shower
 Abdominal massage
o Premenstrual Syndrome
 Premenstrual syndrome (PMS) is a combination of physical and
emotional disturbances that occur after a woman ovulates and ends
with menstruation. Common PMS symptoms include depression,
irritability, crying, oversensitivity, and mood swings.
 Signs and Symptoms
 anger and irritability,
 anxiety,
 tension,
 depression, crying,
 oversensitivity, and exaggerated mood swings
 Treatments
 General management includes a healthy lifestyle including:
o Family and friends can provide emotional support
during the time of a woman's cycle;
o Avoid salt before the menstrual period;
o Reduce caffeine intake;
o Quit smoking;
o Exercise;
o Reduce alcohol intake; and
 Medications
 A variety of medications are used to treat the different
symptoms of PMS.
  Medications include diuretics, pain killers, oral contraceptive
pills, drugs that suppress ovarian function, and
antidepressants.
- Pelvic Inflammatory Disease
o Signs and Symptoms
 Lower abdominal pain, fever, unusual vaginal discharge that may
have a foul odor, painful intercourse, painful urination, irregular
menstrual bleeding, and pain in the right upper abdomen (rare)
o Cervicitis and Cervical Polyps
 Cervicitis is an inflammation of the cervix—the lower part of the
uterus extending about an inch into the vaginal canal.
 Most commonly, cervicitis is the result of an infection, although it
can also be caused by injury or irritation.
 Cervical Polyps
 Cervical polyps are fingerlike growths on the lower part of
the uterus that connects with the vagina (cervix). Cervical
polyps are small, soft, growths that protrude from the mouth
of the cervix.
o Cancer of the Cervix
 There are two major types of cancer that develop from the cervix.
 Squamous cell cancers arise from the squamous epithelium
that covers the visible part of the cervix.
 Adenocarcinomas arise from the glandular lining of the
endocervical canal.
 Nursing Care for Patients with Uterine Cervix Disorders
 Proper health teachings by the nurse will be necessary.
 Recognition of risk is a first step before changes in behavior
occur .
 Patients should bed is courage from assuming that a partner
is “safe”.
 Nonjudgmental attitudes, educational counseling, and role
playing may all be helpful.
 Nurse has a major role in discussion of sex that is safe as
possible.
 Safer sex practices and enhancement of knowledge.
 Nurse’s Therapeutic communication.
 Communicating partners about sex and risk
 Nursing care of these patients is complex and requires
coordination and care by experienced health care
professionals.
- Disorders of the uterus
o Endometritis
 Endometriosis is a condition where tissue similar to the lining of the
uterus is found elsewhere in the body.
 Signs and Symptoms
 The most common symptom of endometriosis is pelvic pain.
Pain may be felt:
 before/during/after menstruation
 during ovulation
 in the bowel during menstruation
 when passing urine
 during or after sexual intercourse
 in the lower back region
 Treatments Pain killers
 Pain killers include:
o Simple analgesics
o Compound analgesics
o Mild narcotics
o Narcotic analgesics
o Non-steroidal anti-inflammatory drugs
 Hormonal therapies
o Hormonal therapies may include:
 The combined oral contraceptive pill (OC)
o Surgery
 Laparoscopic surgery is the only definitive way
to diagnose endometriosis.

o Adenomyosis
 Adenomyosis is benign and does not cause cancer.
 Most commonly, the disease affects the back wall of the uterus.
  BENIGN - a condition, tumor, or growth that is not cancerous
o Endometrial Cancer
 Endometrial cancer refers to several types of malignancy which
arise from the endometrium, or lining of the uterus.
o Leiomyomas
 A leiomyoma is a benign smooth muscle neoplasm that is not
premalignant.
- Ovarian Disorder -- Benign Ovarian Cysts and Tumors
o Ovarian Cysts
 An ovarian cyst is any collection of fluid, surrounded by a very thin
wall, within an ovary.
o Benign and Functioning Ovarian Tumors
 One of a number of benign neoplasms of the ovary that does not
invade tissue or metastasize.
o Ovarian Cancer
 Ovarian cancer is cancer that starts in the ovaries. The ovaries are
the female reproductive organs that produce eggs.
 Nursing Care for Patients with Ovarian Disorders
 Nursing measures include those related to the patient’s
various treatment plan, be it surgery, radiation,
chemotherapy, or palliation.
 Emotional support, comfort measures and information, plus
attentiveness and caring, are meaningful aids to this patient
and her family.
 Patients with advanced ovarian cancer may develop ascites
and pleural effusion.
 Nursing care may include administering intravenous therapy
to alleviate fluid and electrolyte imbalances, intitiating total
parenteral nutrition to provide adequate nutrition, providing
postoperative care after intestinal bypass .
- Vaginal Disorders
o Vaginitis
 Vaginitis is a term for any infection or inflammation of the vagina.
o Cancer of the Vagina
 Cancer of the vagina, is a rare kind of cancer in women. In vaginal
cancer, cancer (malignant) cells are found in the tissues of the
vagina.
- Vulvar Disorder -- Vulvitis and Folliculiltis
o Vulvitis
 simply an inflammation of the vulva, the soft folds of skin outside
the vagina.
o Folliculitis
 Folliculitis is an infection in a hair follicle, which is an opening in the
skin that contains the hair root.
o Bartholin’s Gland Cyst and Abscess
 Bartholin's gland cyst is a swollen fluid-filled lump that develops
from a blockage of one of the Bartholin's glands, which are small
glands located on each side of the opening to the vagina.
o Epidermal Cyst
 Epidermal cysts are also known as epithelial or infundibular cysts
and present as intradermmal or subcutaneous tumours that grow
slowly and occur on the face, neck, back and scrotum.
o Nevi
 Nevi are not uncommon on the vulva, and can have a variety of
color schemes, ranging from brown, brown-black, black, flesh-
colored, or red.
o Vulvar Dystrophy
 Vulvar dystrophy is a degeneration of the vulvar tissue. It occurs in
women who are past menopause.
o Cancer of the Vulva is rare
 Nursing Care for Patients with Vulvar Disorders
 The woman with vulvovaginal symptoms should be
examined as soon as possible after onset of symptoms.
 She is instructed not to douche because doing so removes
the vaginal discharge needed to make the diagnosis.
 The major goal for a nurse for the patient include relief of
pain and discomfort; reduction of anxiety related to stress
symptoms; prevention of reinfection or infection of sexual
partner; and acquisition of knowledge about methods for
preventing vulvovaginal infections and managing self-care.
  The nurse may need to reinforce instructions for warm
perineal irrigations .
 Nurses must discuss ways to help prevent vulvovaginal
infections
 The nurse should also stress the importance of hand
washing before and after each administration of medication
especially topical creams and suppositories.
 The key to nursing responsibilities for patients with vulvar
dystrophies focus on teaching

Nursing Care of a Family with an Ill Child

- Illness is traumatic to children
- They can visit the hospital to familiarize themselves with equipment
- Definition of illness
o Parallels cognitive development
o Factors affecting meaning
o Cognitive ability
o Past experiences
o Level of knowledge
o Difference in responses of children and adults to illness
o Inability to communicate
o Inability to monitor their own care and manage fear
o Nutritional needs
o Fluid and electrolyte balance
o Systemic response to illness
o Age-specific diseases
- Preparations
o Family
o Infant
o Toddler or preschooler
o School-age child or adolescent
o Different cultural background
o Physically ill or chronically ill
o Include the Family during the admission process