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• The primary roles of female reproductive system are production of ova, secretion of
hormones, and protection and facilitation of the development of the fetus in a pregnant
female.
o The primary female reproductive organs are the ovaries.
• The hypothalamus, pituitary gland, and gonads secrete numerous hormones that regulate the
processes of ovulation, spermatogenesis, fertilization, and formation and function of
secondary sex characteristics.
• The major gonadal hormone of men is testosterone, which is produced by the testes.
Testosterone is responsible for development and maintenance of secondary sex
characteristics and spermatogenesis.
• Menarche is the first episode of menstrual bleeding, indicating that a female has reached
puberty.
o This usually occurs at 12 to 13 years of age.
o The length of the menstrual cycle generally ranges from 20 to 40 days.
• The major functions of ovaries are ovulation and secretion of hormones. These functions are
accomplished during the menstrual cycle.
• If fertilization occurs, high levels of estrogen and progesterone continue to be secreted due
to continued activity of corpus luteum from stimulation by human chorionic gonadotropin
(hCG).
o If fertilization does not take place, menstruation occurs because of a decrease in
estrogen production and progesterone.
Gerontologic Considerations
• In women, many changes relate to the altered estrogen production of menopause.
ASSESSMENT
• Nurses have an important role in providing accurate and unbiased information about
sexuality and age. Nurses should emphasize normalcy of sexual activity in older adults.
• Reproduction and sexual issues are often considered extremely personal and private.
o A professional demeanor is important when taking a reproductive or sexual
history.
o The nurse needs to be sensitive, ask gender-neutral questions, and maintain
awareness of patient’s culture and beliefs.
o It is helpful if the nurse begins with least sensitive information (e.g., menstrual
history) before asking questions about more sensitive issues such as sexual
practices or sexually transmitted diseases.
• Women should have a complete menstrual and gynecologic history taken, including oral
contraceptive use.
o The nurse should question the patient regarding current health status and
presence of any acute or chronic health problems as problems in other body
systems often relate to problems with reproductive system.
• Physical examination:
o Male external genitalia: inspection and palpation of pubis, penis, scrotum and
testes, inguinal region and spermatic cord, anus and prostate.
o Female: begins with inspection and palpation of breasts and then proceeds to
abdomen and external genitalia including mons pubis, labia majora, labia
minora, perineum, and anal region.
o Pelvic and bimanual examinations are considered advanced skills.
DIAGNOSTIC STUDIES
• Serum hormone test, hCG, is used to identify pregnancy.
• Serum progesterone and estradiol can also help in ovarian function assessment, particularly
for amenorrhea.
• Screening guidelines for early detection of breast cancer are yearly mammograms
starting at age 40, and clinical breast examinations every 3 years for women between
ages 20 and 30 and every year for women beginning at age 40.
• Women should report any breast changes promptly to their health care provider.
• Women at increased breast cancer risk (family history, genetic tendency, past breast
cancer) should talk with their health care provider about benefits and limitations of
starting mammography screening earlier, having additional tests (breast ultrasound), or
having more frequent examinations.
• Mammography is used to visualize internal structures of the breast using x-rays. This
procedure can detect tumors and cysts not felt by palpation.
• Mastitis:
o Mastitis is a breast inflammatory condition that occurs most frequently in
lactating women.
o Lactational mastitis manifests as a localized area that is erythematous,
painful, and tender to palpation.
o Fever is usually present. Infection develops when organisms, usually
staphylococci, gain access to breast through cracked nipple.
o In its early stages, mastitis can be cured with antibiotics.
BREAST CANCER
• Breast cancer is the most common malignancy in American women except for skin
cancer.
• Noninvasive breast cancers include ductal carcinoma in situ (DCIS) and lobular
carcinoma in situ (LCIS).
o DCIS tends to be unilateral and most likely would progress to invasive breast
cancer if left untreated.
o LCIS is a risk factor for developing breast cancer, but it is not known to be a
premalignant lesion. No treatment is necessary for LCIS. Tamoxifen may be given as
a chemoprevention.
• Paget’s disease:
o Paget’s disease is a rare breast malignancy characterized by a persistent lesion of the
nipple and areola with or without a palpable mass.
o Treatment is a simple or modified radical mastectomy.
• If palpable, breast cancer is usually hard, and may be irregularly shaped, poorly delineated,
nonmobile, and nontender. Nipple discharge may also be present.
• In addition to earlier listed tests, other tests useful in predicting risk of recurrence or
metastatic breast disease include axillary lymph node status, tumor size, estrogen and
progesterone receptor status, and cell proliferative indices.
• Patients with breast cancer should discuss all treatment options with their health care
provider, including local excision, mastectomy with breast reconstruction, breast-
conserving treatment (lumpectomy), radiation therapy, and/or tamoxifen.
• Common options for resectable breast cancer include breast conservation surgery with
radiation therapy and modified radical mastectomy with or without reconstruction.
• Breast conservation surgery (lumpectomy) involves removal of entire tumor along with a
margin of normal tissue. Modified radical mastectomy includes removal of breast and
axillary lymph nodes, but it preserves pectoralis major muscle.
• Lymphedema can occur due to surgical excision or radiation of lymph nodes. Symptoms
are heaviness, pain, impaired motor function in the arm, and numbness and paresthesia of
the fingers as a result of lymphedema.
• Following surgery, radiation therapy is delivered to the entire breast, ending with a boost to
the tumor bed. If there is evidence of systemic disease, then chemotherapy may be given
before radiation therapy.
• Radiation therapy may be used for breast cancer as a primary treatment to prevent local
breast recurrences after breast conservation surgery, adjuvant treatment following
mastectomy to prevent local and nodal recurrences, and palliative treatment for pain caused
by local recurrence and metastases.
• Breast cancer is one of the solid tumors most responsive to chemotherapy with the use of
combinations of drugs, which is clearly superior to use of single drug therapy.
• Hormonal therapy removes or blocks the source of estrogen, thus promoting tumor
regression.
• Nursing interventions at time of breast cancer diagnosis include exploring woman’s usual
decision-making patterns, helping the woman accurately evaluate advantages and
disadvantages of options, and providing information and support relevant to treatment
decisions.
• The woman with breast conservation surgery usually has an uneventful postoperative course
with only a moderate amount of pain. If an axillary lymph node dissection or mastectomy is
done, drains are often left in place.
• Mammoplasty:
o Mammoplasty is a surgical change in size or shape of the breast.
o It may be done electively for cosmetic purposes to either augment or reduce the size
of breasts or to reconstruct the breast after mastectomy.
o In augmentation, an implant is placed in a surgically created pocket between the
capsule of the breast and the pectoral fascia.
o Reduction mammoplasty is performed by resecting wedges of tissue from upper and
lower quadrants of breast.
• Breast reconstructive surgery may be done simultaneously with mastectomy or some time
afterward to achieve symmetry and to restore or preserve body image.