Iggy 69 Reproductive

When does the American Cancer Society (ACS) advise all women to begin having an annual Pap test?

- 21 years of age. Women younger than 21 years should not be tested

The ovaries

- A pair of almond-shaped organs located near the lateral walls of the upper pelvic cavity. - After menopause, they become smaller. - These small organs develop and release ova and produce the sex steroid hormones (estrogen, progesterone, androgen, and relaxin).

The testes

- A pair of oval organs in the scrotum that produce sperm and testosterone. - Each teste is suspended in the scrotum by the spermatic cord, which provides blood, lymphatic, and nerve supply to the testis. - Sympathetic nerve fibers are located on the arteries in the cord, and sympathetic and parasympathetic fibers are on the vas deferens. - When the testes are damaged, these autonomic nerve fibers transmit excruciating pain and a sensation of nausea.

The scrotum

- A thin-walled, fibromuscular pouch behind the penis and suspended below the pubic bone. - Protects the testes, epididymis, and vas deferens in a space that is slightly cooler than inside the abdominal cavity. - The scrotal skin is darkly pigmented and contains sweat glands, sebaceous glands, and few hair follicles. - It contracts with cold, exercise, tactile stimulation, and sexual excitement.

Breast biopsy

- All breast masses should be evaluated for the possibility of cancer. - Fibrocystic lesions, fibroadenomas, and intraductal papillomas can be differentiated by biopsy. -Any discharge from the breasts is examined histologically.

What is the nurses role immediately before the pelvic and breast examinations?

- Ask patient to empty her bladder and undress completely. - Drape the patient adequately to provide modesty throughout the examination. - Remove drapes only over the region being examined /replace them after that area is assessed. - Mirrors (may be used to facilitate teaching) - Room needs adequate lighting, comfortable temperature, and ensures privacy.

How should the nurse assess the patients nutritional Hx?

- Ask the patient to recall his or her dietary intake for a recent 24-hour period to assess nutritional quality. - Assess height, weight, and BMI. - The patient may be hesitant to discuss practices such as bingeing, purging, anorexic behaviors, or excessive exercise.

What color should fluid aspirated from a breast biopsy be?

- Aspirated fluid from benign cysts may appear clear to dark green-brown. - Bloody fluid suggests cancer. - These specimens undergo histologic evaluation. - If cancer is found, the tissue is evaluated for estrogen receptor analysis.

ACS recommendations for Paps after age 21?

- Between ages 21 and 29 years, women should have a Pap test every 3 years - between ages 30 and 65 years should have a Pap test plus a human papilloma virus (HPV) test ("co-testing") every 5 years. - women older than 65 years who have had regular cervical cancer testing with normal results do not need Pap testing - other health care organizations suggest a Pap test every 3 years for women older than 60 years. - Those who have had a history of a serious cervical precancerous lesion should be tested ANNUALLY for AT LEAST 20 years after that diagnosis, regardless of age

What are Canadian guidelines for Paps?

- Canadian guidelines are similar - state that women should begin ANNUAL Pap testing at either 21 or 25 years of age, depending on the province. - Between 30 and 69 years, women should have a Pap test every 3 years. - After 70, Pap tests are not needed

What educational information is important to relay to the aging female patient, pertaining to reproductive changes?

- Discuss changes - Provide info about vaginal estrogen therapy and water-soluble lubricants. (helps them know their options) - information about Kegel exercises to strengthen pelvic muscles. (can help urinary incontinence) - Teach or reinforce the importance of breast self-awareness, clinical breast examinations, and mammography.

How can the nurse reassure the patient?

- Explain each step of the assessment procedure before it is performed. - The patient needs to be reassured that the health care provider will stop and change the assessment plan or technique if the patient experiences pain during the examination. - Teach relaxation techniques and provide nonjudgmental support (increases comfort), especially during the rectal examination to palpate the prostate gland.

Why is nutrition history is important when assessing the reproductive system?

- Fatigue and low libido may occur as a result of poor diet and anemia. - The World Cancer Research Fund estimates that about 1/4 to 1/3 of new preventable cancer cases in the United States are related to overweight or obesity, physical inactivity, and poor nutrition - A certain level of body fat and weight is necessary for the onset of menses and the maintenance of regular menstrual cycles. - Decreased body fat results in insufficient estrogen levels.

Special dietary needs of women

- Heavy menstrual bleeding, particularly in women who have IUDs, may require iron supplements. - Teach all women about their body's need for calcium. (especially important during and after menopause to help prevent osteoporosis caused by decreased estrogen production )

Perineum

- In females, area between vagina and anus - In males, external region between the anus and scrotum - skin of the perineum covers the muscles, fascia, and ligaments that support the pelvic structures

What should the nurse consider about the male patients psyche during a reproductive exam?

- Men are often embarrassed and anxious - patient may be concerned about impaired comfort, the developmental stage of his genitalia, or the possibility of an erection during the examination.

Do physicians always perform a male reproductive assessment?

- No - Unless patient seeks health care for a specific problem - Also depending on the setting and the age of the patient.

Preparing patient for prostate biopsy

- Preparation for the procedure depends on the technique used to puncture the gland. - Explain to the patient that he may experience some discomfort. -Teach him about breathing and relaxation techniques that may be helpful to use during the procedure. - allow him time to discuss his anxieties and fears. TRANSRECTAL BIOPSY - assist into the side-lying position with his knees pulled up toward his chest. - The primary health care provider will cleanse the area, apply gel, and then insert a thin ultrasound probe into the patient's rectum to anesthetize (if needed) and guide the biopsy needle into place. - The biopsy is collected over a 5- to 10-minute period. - patient may experience a brief, uncomfortable feeling each time the needle collects a sample. AFTER BIOPSY - educate the patient to take the entire prescribed antibiotic. - Remind him that he may experience slight soreness, light rectal bleeding, and blood in the urine or stools for a few days. - Semen may be red or rust colored for several weeks. -Teach the patient to contact his primary health care provider if he has prolonged or heavy bleeding, worsening pain, swelling in the area of biopsy, and/or difficulty urinating. -Rarely, sepsis can develop after a prostate biopsy. Teach the patient to contact his primary health care provider immediately if he experiences fever, pain when urinating, or penile discharge.

Preparing the patient for mammogram

- Remind the patient not to use creams, lotions, powders, or deodorant on the breasts or underarms before the study because these products may be visible on the mammogram and lead to misdiagnosis. - If there is any possibility that the patient is pregnant, the test should be rescheduled. - Explain the purpose of the study and its anticipated discomforts. - Allow the patient to express concerns about the mammogram and the presence of any lumps.

When assessing a patient, the nurse must be sensitive to:

- Sexual orientation - Gender Identification - Cultural /religious beliefs (can affect sexual practices, the acceptable number of sexual partners, and contraceptive use)

What educational information is important to relay to the aging male patient, pertaining to reproductive changes?

- Teach or reinforce the importance of testicular self-examination (TSE) (may detect changes that may indicate cancer) - Teach the patient the signs of urethral obstruction and the importance of prostate cancer screening. (help detect changes/ cancer earlier)

Patient care post breast biopsy

- Tell women to wear a properly supportive bra continuously for 1 week after surgery or as recommended by their surgeon. - Remind the patient that numbness around the biopsy site may last several weeks. - If cancer is identified, provide emotional support and reinforce information about follow-up treatment options.

The epididymis

- The first portion of a ductal system that transports sperm from the testes to the urethra - site of sperm maturation.

What is the clinical nurse generalist role in a comprehensive female or male reproductive examination?

- The nurse does not perform a comprehensive reproductive examination, the primary health care provider does; the nurse often assists with the examination. - Although, you should perform a focused assessment related to specific concerns of the patient.

Testosterone

- The primary male hormone for sexual development and function - Production is fairly constant in the adult male. Only a slight and gradual reduction occurs in the older adult male - until he is in his 80s. - Low testosterone levels decrease muscle mass, reduce skin elasticity, and lead to changes in sexual performance.

When to perform a hysterosalpingogram

- The study should not be attempted for at least 6 weeks after abortion, delivery, or dilation and curettage. - Other contraindications include reproductive tract infection and uterine bleeding. - The examination is best performed in the first half (days 1 to 14) of the patient's menstrual cycle (reduces the chance that the patient may be pregnant)

Mammography procedure

- The technician or assistant provides a gown and privacy for the woman to undress above the waist. - technician positions the patient next to the x-ray machine with one breast exposed. - A film plate and the platform of the machine are placed on opposite sides of the breast to be examined. - The technician includes as much breast tissue as possible between the plates. - The woman may experience some temporary discomfort when the breast is compressed (for about a minute for each of four positions). - Entire test takes about 15 minutes. - The patient usually is asked to wait until the films are reviewed in case a view needs to be repeated.

3D mammography (tomosynthesis)

- This technology allows the radiologist to visualize through layers or "slices" of breast tissue, similar to a CT scan. - If a digital mammogram is performed, the images are recorded and saved as computer files - Medicare and most other health insurances pay for this newer and more expensive technology because it improves diagnosis accuracy. - Inform the patient when to expect the report of the results.

Bartholin glands

- Two glands, located deeply toward the back on both sides of the vaginal opening - secrete lubrication fluid during sexual excitement. - Their ductal openings are usually not visible.

Labia Minora

- Two medial, thinner, vertical folds of reddish epithelium - highly vascular and have a rich nerve supply. - Emotional or physical stimulation produces marked swelling and sensitivity - Numerous sebaceous glands in the labia minora lubricate the entrance to the vagina.

labia majora

- Two vertical folds of adipose tissue that extend posteriorly from the mons pubis to the perineum. - Skin covering labia major is usually darker than the surrounding skin and is highly vascular - Sizes vary, depending on the amount of fatty tissue present - It protects inner vulval structures and enhances sexual arousal

Prostate biospy

- When prostate cancer is suspected, a biopsy must be performed. - can be done by transurethral biopsy, by inserting a needle through the area of skin between the anus and scrotum - or, most commonly, by transrectal biopsy.

The vas deferens (or ductal deferens)

- a firm, muscular tube that continues from the tail of each epididymis. - The end of each vas deferens is a reservoir for sperm and tubular fluids. - They merge with ducts from the seminal vesicle to form the ejaculatory ducts at the base of the prostate gland. - Sperm from the vas deferens and secretions from the seminal vesicles move through the ejaculatory duct to mix with prostatic fluids in the prostatic urethra.

Female Breasts

- a pair of mammary glands that develop in response to secretions from the hypothalamus, pituitary gland, and ovaries. - The breasts are an accessory of the reproductive system that nourish the infant after birth.

The cervix

- a short, narrowed portion of the uterus (1 inch) - Between the body and the vagina. - Site for Papanicolaou (Pap) testing.

Ultrasonography (US)

- a technique used to assess fibroids, cysts, and masses. - It can be used to monitor the progress of tumor regression after medical treatment. - also helpful in differentiating solid tumors from cysts in breast examinations. - In men, ultrasound can test for varicoceles, scrotal abnormalities, and problems of the ejaculatory ducts and seminal vesicles and the vas deferens

colposcope

- allows three-dimensional magnification and intense illumination of epithelium with suspected disease. - suited for inspection of a female patient's cervical epithelium, vagina, and vulvar epithelium. Because it provides accurate site selection - this procedure can locate the exact site of premalignant and malignant lesions for biopsy. - uses colposcope / biopsy can be taken

What should the nurse do if the patient is erect during exam?

- assure him that this is a normal response to a tactile stimulus (touch) and continue the examination.

How are the breasts supported?

- by ligaments that are attached to underlying muscles. - They have abundant blood supply and lymph flow that drain from an extensive network toward the axillae.

Cytologic vaginal cultures

- can detect bacterial, viral, fungal, and parasitic disorders - Examination of cells from the vaginal walls can evaluate estrogen balance.

human papilloma virus (HPV) test

- can identify many high-risk types of HPV infection associated with the development of cervical cancer. - can be done at the same time as Pap test for women older than 30 years /or of any age who have had an abnormal Pap test result - does not take the place of the Pap - tests for viruses that can cause cell changes in the cervix that, if not treated, could lead to cancer. - Cells are collected from the cervix and sent to a laboratory for analysis. - Women who have normal Pap test results and no HPV infection are at very low risk for developing cervical cancer. - Women with an abnormal Pap test result and a positive HPV test are at higher risk if not treated.

Papanicolaou test (Pap test), or Pap smear

- cytologic study that is effective in detecting precancerous and cancerous cells within the female patient's cervix. - done immediately before the pelvic examination. - speculum is inserted into the vagina, several samples of cells from the cervix are obtained with a small brush or spatula. - The specimens are placed on a glass slide and sent to the laboratory for examination.

A history of infections or prolonged fever in males may cause?

- damaged sperm production - or obstruction of the seminal tract, which can cause infertility.

Disorders that affect a woman's metabolism or nutrition can lead to?

- depressed ovarian function - and cause amenorrhea (absence of menses). .

Serologic studies

- detect antigen-antibody reactions that occur in response to foreign organisms. - helpful only after an infection has become well established. - can be used in the evaluation of exposure to organisms causing syphilis, rubella, and herpes simplex virus type 2 (HSV2). - Results may be read as nonreactive, weakly reactive, or reactive. - A single titer is not as revealing as serial titers, which can detect the rise in antibody reactions as the body continues to fight the infection.

Laparoscopy

- direct examination of the pelvic cavity through an endoscope. - This procedure can rule out an ectopic pregnancy, evaluate ovarian disorders and pelvic masses, and aid in the diagnosis of infertility and unexplained pelvic pain.

Importance of Family Hx

- helps determine the patient's risk for conditions that affect reproductive functioning. - A delayed or early development of secondary sex characteristics may be a familial pattern. - Evidence of medical diseases or reproductive problems in family members provides a fuller understanding of the patient's current symptoms. - Daughters of women who were given diethylstilbestrol (DES) to control bleeding during pregnancy are at increased risk for infertility and reproductive tract cancer. - Specific BRCA1 and BRCA2 gene mutations increase the overall risk for breast or ovarian cancer. - Men with first-degree relatives with prostate cancer are at greater risk for the disease than the general population.

Most common reasons patients seek reproductive medical attention

- impaired comfort - bleeding - discharge - masses

The fallopian tubes (uterine tubes)

- insert into the fundus of the uterus and extend laterally close to the ovaries. - They provide a duct between the ovaries and the uterus for the passage of ova and sperm. - In most cases, the ovum is fertilized in these tubes.

Preparing patients to have a hysterosalpingogram

- instruct to follow the recommendations of their health care provider, which may include taking an OTC pain reliever before the procedure. Day of the examination: - confirm the date of last menstrual period. - Ask about allergies to iodine dye or shellfish. - The primary health care provider provides information about benefits and risks of the procedure with the patient. - Nurse may witness the signed informed consent - Patient may experience some nausea and vomiting, abdominal cramping, or faintness during the procedure. - Provide support and assistance with relaxation techniques as needed. - The patient may experience pelvic pain after the study and should receive analgesic medications as ordered. - Inform her that she may also have referred pain to the shoulder because of irritation of the phrenic nerve. - Provide a perineal pad after the test to prevent soiling of clothes as the dye drains from the cervix. - Instruct the patient to contact her primary health care provider if bloody discharge continues for 4 days or longer and to immediately report any signs of infection, such as lower quadrant pain, fever, malodorous discharge, or tachycardia.

How do CT scans help in diagnoses of the reproductive system?

- involve the abdomen and the pelvis. - Primary health care providers can detect and evaluate masses and identify lymphatic enlargement from metastasis. -This scan can differentiate solid tissue masses from cystic or hemorrhagic structures.

The prostate gland

- large accessory gland of the male reproductive system - can be palpated via the rectum. - secretes a milky alkaline fluid that adds bulk to the semen, enhances sperm movement, and neutralizes acidic vaginal secretions. - Men older than 50 years commonly have an enlarged prostate (benign prostatic hyperplasia [BPH]), which can cause problems such as overflow incontinence and nocturia (nighttime urination). - Prostate function depends on adequate levels of testosterone.

The vestibule

- longitudinal area between the labia minora, the clitoris, and the vagina - contains: Bartholin glands the openings of the urethra Skene's glands (paraurethral glands) and vagina.

Why is the psychosocial aspect important in examination? What should you ask?

- may provide information about factors that affect the patient's health status. - ask about sources of support, strengths, and coping reactions to illness or dysfunction.

The penis

- organ for urination and intercourse - consisting of the body or shaft and the glans penis (the distal end of the penis). - The glans is the smooth end of the penis and contains the opening of the urethral meatus. - A continuation of skin covers the glans and folds to form the prepuce (foreskin).

What does the recessed pockets around the cervix permit?

- palpation of the internal pelvic organs. - The posterior area provides access into the peritoneal cavity for diagnostic or surgical purposes.

What happens during Gyno exam?

- primary health care provider palpates for abdominopelvic masses. (patient arms at side or on stomach to relax ab muscles) -Gynecologic masses, such as ovarian masses, may be further differentiated from lesions on the body of the uterus during the bimanual portion of the pelvic examination.

Hysteroscopy

- procedure that uses a fiberoptic camera to visualize the uterus to diagnose and treat causes of abnormal bleeding. -The hysteroscope includes a fiberoptic camera that is inserted into the vagina to examine the cervix and uterus. - best performed 5 days after menses has ceased to reduce the possibility of pregnancy. - Analgesics may be prescribed if the patient has cramping or shoulder pain.

Things to know when scheduling Pap smear

- scheduled between the patient's menstrual periods so the menstrual flow does not interfere with laboratory analysis. - Teach women not to douche, use vaginal medications or deodorants, or have sexual intercourse for at least 24 hours before the test, because these may interfere with test interpretation.

clitoris

- small, cylindric organ that is composed of erectile tissue with a high concentration of sensory nerve endings. - During sexual arousal, the clitoris becomes larger and increases sexual sensation.

Mammograms in older women

- the amount of fatty tissue is higher, and the fatty tissue appears lighter than cancers. - Cancer and cysts may have the same density. - Cysts usually have smooth borders, and cancers often have starburst-shaped margins.

The physical examination of the female reproductive system includes:

- the breasts - abdomen - pelvic examination.

transvaginal or transrectal scan

- transducer is covered with a condom - transmission gel on condom - The transducer is then inserted into the vagina or rectum as indicated. - Women should have an empty or only partially filled bladder - if incontinent, a urinary catheter may be inserted and filled with fluid to allow optimal visualization. - Patients might feel some mild impaired comfort associated with pressure of the probe.

The prostate-specific antigen (PSA) test

- used to screen for prostate cancer and to monitor the disease after treatment. - PSA levels less than 2.5 ng/mL may be considered normal, although there is no agreement on that value and how it is affected by age. - Elevated PSA levels may be associated with prostate cancer. - Older men, particularly African-American men, often have a higher than normal PSA, especially as they age

MRI (magnetic resonance imaging)

- uses a magnetic field and radiofrequency energy to distinguish between normal and malignant tissues. - used in addition to mammograms to assess for breast cancer in women who have a genetic risk - The use of MRI in evaluating patients with dense breast tissue may reduce the need for biopsy. - also used to detect pelvic tumors.

Salpingitis

- uterine tube infection - is often caused by chlamydia and can result in female infertility.

Patients with diabetes mellitus may experience physiologic changes such as

- vaginal dryness - impotence.

Hysterosalpingogram

- x-ray that uses an injection of a contrast medium to visualize the cervix, uterus, and fallopian tubes. - used to evaluate tubal anatomy and patency and uterine problems such as fibroids, tumors, and fistulas.

Mammograms in young women

- young women's breasts have little difference in the density between normal glandular tissue and malignant tumors, which makes the mammogram less useful for evaluation of breast masses in these women. - For this reason, annual screening mammograms are not recommended for women younger than 40 years

What is normal pH in the vagina?

3.5 -5.0 (acidic)

What is breast tissue composed of? and in what proportions?

A network of: - glandular and ductal tissue - fibrous tissue - fat. The proportion of each component of breast tissue depends on: - genetic factors - nutrition - age - and obstetric history.

When the patient complains of discharge issues, nurse must assess

Amount and character of discharge Presence of genital lesions, bleeding, itching, or pain Presence of symptoms or discharge in sexual partner (this can be embarrassing and cause anxiety -- causes are infections / STIs/ tight clothing/ drugs)

Types of reproductive biopsy:

Cervical, Endometrial, Breast, Prostate

Female sex steroid hormones

Estrogen, progesterone, androgen, and relaxin - Adequate amounts of these hormones are needed for normal female growth and development and to maintain a pregnancy.

What changes occur in the female reproductive system as women age?

Graying and thinning of the pubic hair Decreased size of the labia majora and clitoris Drying, smoothing, and thinning of the vaginal walls Atrophy of the endometrium Decreased size and marked convolution of the ovaries Loss of tone and elasticity of the pelvic ligaments and connective tissue Increased flabbiness and fibrosis of the breasts, which hang lower on the chest wall; decreased erection of the nipples

What changes occur in the male reproductive system as men age?

Graying and thinning of the pubic hair Increased drooping of the scrotum and loss of rugae Prostate enlargement, with an increased likelihood of urethral obstruction

When the patient complains of masses, nurse must assess

Location and characteristics of mass Presence of associated symptoms, such as pain Relationship to menstrual cycle (breasts, testes, or inguinal area are evaluated)

17-Ketosteroids (URINE STUDY)

Men (20-50 yr): 6-20 mg/24 hr Women (20-50 yr): 6-17 mg/24 hr Values decrease with age Elevations indicate possible Cushing's syndrome, increased androgen or cortisol production, severe stress. Decreased levels indicate possible Addison's disease, hypopituitarism.

Estriol

Men and nonpregnant women: N/A Decreased levels of estradiol, total estrogens, and estriol in women indicate possible: amenorrhea, climacteric, impending miscarriage, hypothalamic disorders.

Pregnanediol (URINE STUDY)

Men: 0-1.9 mg/24 hr Women: follicular phase, <2.6 mg/24 hr luteal phase, 2.6-10.6 mg/24 hr Elevations indicate possible luteal ovarian cysts, ovarian neoplasms, adrenal disorders. Decreased levels indicate possible amenorrhea.

Prostate-specific antigen (PSA)

Men: 0-2.5 ng/mL Increased levels may indicate prostatitis, benign prostatic hyperplasia, prostate cancer.

Luteinizing hormone (LH) (Lutropin)

Men: 1.24-7.8 units/L Women: follicular phase, 1.68-15 units/L midcycle, 21.9-56.6 units/L luteal phase, 0.61-16.3 units/L postmenopause, 14.2-52.3 unis/L Decreased levels indicate possible infertility, anovulation. Elevations indicate possible ovarian failure, Turner's syndrome.

Follicle-stimulating hormone (FSH) (Follitropin)

Men: 1.42-15.4 IU/L Women: follicular phase, 1.37-9.9 units/L midcycle, 6.17-17.2 units/L luteal phase, 1.09-9.2 unis/L postmenopause, 19.3-100.6 units/L Decreased levels indicate possible infertility, anorexia nervosa, neoplasm. Elevations indicate possible Turner's syndrome.

Progesterone

Men: 10-50 ng/dL Women: follicular phase, <50 ng/dL luteal phase, 300-2500 ng/dL postmenopausal, <40 ng/dL Decreased levels in women indicate possible inadequate luteal phase, amenorrhea. may indicate ovarian neoplasm, ovarian dysfunction. Elevations in women indicate possible ovarian luteal cysts.

Estradiol

Men: 10-50 pg/mL Women: follicular phase, 20-350 pg/mL midcycle, 150-750 pg/mL luteal phase, 30-450 pg/mL postmenopause, ≤20 pg/mL Elevations of estradiol, total estrogens, and estriol in men indicate possible: gynecomastia, decreased body hair, increased fat deposits, feminization, testicular tumor Elevations in women = ovarian tumor.

Testosterone

Men: 280-1080 ng/dL Women: <70 ng/dL Increased levels in men indicate possible testicular tumor, hyperthyroidism. Decreased levels in men indicate possible hypogonadism. Elevations in women indicate possible adrenal neoplasm, ovarian neoplasm, polycystic ovary syndrome.

Prolactin

Men: 3-13 ng/mL Women: 3-27 ng/mL Pregnant women: 20-400 ng/mL Elevations indicate possible: galactorrhea (breast discharge), pituitary tumor, disease of hypothalamus or pituitary gland, hypothyroidism.

Total estrogens (URINE STUDY)

Men: 4-25 mcg/24 hr Women: 4-60 mcg/24 hr Elevations indicate possible testicular tumors. Decreased levels indicate possible ovarian dysfunction.

What influences the amounts of glycogen and lubricating fluid secreted by the vaginal cells?

Ovarian hormones (primarily estrogen)

When the patient complains of bleeding issues, nurse must assess

Presence or absence of bleeding Character and amount of bleeding Relationship of bleeding to events or other factors (e.g., menstrual cycle, exercise, sex) Onset and duration of bleeding Presence of associated symptoms, such as pain Possibility of pregnancy? Postmenopausal bleeding must be assessed

Masses found can be of what origin?

Reproductive, intestinal, or urinary tract origin

How is vagina pH maintained?

The normal vaginal bacteria (flora) interact with the secretions to produce lactic acid and maintain an acidic pH (3.5 to 5.0) in the vagina. - This acidity helps prevent infection in the vagina.

The first health care professional to assess the patient with a reproductive system health problem or hear a patient's concern about a reproductive problem is often ______

The nurse

The major internal sex organs for males:

The testes and prostate gland.

T or F: Chronic disorders of the nervous system, respiratory system, or cardiovascular system can alter the sexual response

True

T or F: the nurse should assess for chronic illnesses or surgeries that could affect reproductive function.

True

When the patient complains of pain, nurse must assess

Type and intensity of pain Location and duration of pain Factors that relieve or worsen pain Relationship to menstrual, sexual, urinary, or GI function Medications If sleep is affected

Mons Pubis

a fat pad that covers the symphysis pubis and protects it during coitus

what percentage of breast cancer occurs in men?

about 1% of breast cancers occur in men

Mammography

an x-ray of the soft tissue of the breast. - assess differences in the density of breast tissue. - especially helpful in evaluating poorly defined masses, multiple masses or nodules, nipple changes or discharge, skin changes, and impaired comfort. - can detect many cancers that are not palpable by physical examination. However, some actual cancers may not appear on mammography or may appear as benign.

Vulva

external female genitalia from mons pubis to anal opening

During a reproductive assessment, the nurse must be aware of and sensitive to

gender identity and differences in sexual orientation and practices

Vagina

hollow tube that extends from the vestibule to the uterus.

Mumps in men may cause what???

orchitis (painful inflammation and swelling of the testes) and can lead to testicular atrophy and sterility

Pelvic inflammatory disease or a ruptured appendix, followed by peritonitis can cause?

pelvic scarring and strictures/ adhesions in the fallopian tubes.

Conization

removal of a cone-shaped sample of tissue - A type of biopsy - can be done as a cold-knife procedure, a laser excision, or an electrosurgical incision

Radiation therapy, prolonged use of corticosteroids, internal or external estrogen, testosterone, or chemotherapy drugs can all lead to

reproductive system dysfunction.

In a male, the urethra is a pathway for what?

the exit of both urine and semen.

The uterus ("womb")

thick-walled, muscular organ attached to the upper end of the vagina - pear-shaped organ - located within the true pelvis, between the bladder and the rectum. - Made up of the body and the cervix.

Patient recovering from a cervical biopsy

• Do not lift any heavy objects until the site is healed (about 2 weeks). • Rest for 24 hours after the procedure. • Report any excessive bleeding (more than that of a normal menstrual period) to your health care provider. • Report signs of infection (fever, increased pain, foul-smelling drainage) to your health care provider. • Do not douche, use tampons, or have vaginal intercourse until the site is healed (about 2 weeks). • Keep the perineum clean and dry by using antiseptic solution rinses (as directed by your health care provider) and changing pads frequently.

Other than determining pregnancy or infertility, a pelvic examination is indicated to assess for:

• Menstrual irregularities • Unexplained abdominal or vaginal pain • Vaginal discharge, itching, sores, or infection • Rape trauma or other pelvic injury • Physical changes in the vagina, cervix, and uterus

A patient's personal experiences, culture, and/or spiritual beliefs may influence his or her sexuality and ability to enjoy a satisfactory sex life. These factors may include:

• Sexual trauma or abuse inflicted during childhood or adulthood • Punishment for masturbation • Psychological trauma • Cultural influences, such as the idea of female passivity during intercourse • Concerns about sexual partners or sexual lifestyle • Use of alcohol or street drugs

Laparoscopy is also used during surgical procedures such as:

• Tubal sterilization • Ovarian biopsy • Cyst aspiration • Removal of endometriosis tissue • Lysis of adhesions around the fallopian tubes • Retrieval of "lost" intrauterine devices