HUMAN SPECIES

could not survive without functional reproductive systems.

REPRODUCTIVE SYSTEMS
play essential roles in the
development of the structural and functional differences between males
and females, influence behavior,
and produce offspring.
MALE REPRODUCTIVE SYSTEM
MALE REPRODUCTIVE FUNCTIONS

Production of sperm cells

Sustaining and transfer of the sperm cells to the female

Production of male sex hormones

SPERMATOGENESIS
The SPERM Cell
INTERNAL REPRODUCTIVE STRUCTURES
General Function
FEMALE REPRODUCTIVE SYSTEM
FEMALE REPRODUCTIVE FUNCTIONS

Production of female sex cells

Reception of sperm cells from the male

Nurturing the development and providing nourishment for the new

individual
Production of female sex hormone
EXTERNAL REPRODUCTIVE STRUCTURES

INTERNAL REPRODUCTIVE STRUCTURES

OOGENESIS
The OVARIAN cycle
Hormonal Control of Ovarian Cycle
The Menstrual Cycle & its relation to the Ovarian Cycle
FERTLIZATION

ASSESSMENT
Laboratory tests
~ Androstenedione level
~ Estradiol, serum
~ Estriol
~ Estrogen-progesterone receptor assay
~ Estrogen, urine
Laboratory tests
~ Androstenedione level
~ Estradiol, serum
~ Estriol
~ Estrogen-progesterone receptor assay
~ Estrogen, urine
~ Follicle stimulating hormone (FSH), serum
~ FTA-ABS
~ Gram stain
~ Human chorionic gonadotropin (hCG), serum: Luteinizing
hormone, plasma
~ Pregnanetriol, urine
~ Progesterone, plasma
~ Prolactin, serum
~ PSA
~ Prostatic acid phosphatase
~ Semen analysis
~ Testosterone, serum or plasma
~ VDRL
RADIOLOGY STUDIES

Soft tissue mammography

Contrast mammography

Ultrasonography

Computed tomography (CT) scan

CYTOLOGY

Papanicolaou (Pap) smear

Nipple discharge examination

Breast biopsy
~

Aspiration biopsy

Incisional biopsy

Excisional biopsy

Tru-cut or core biopsy

Stereotactic needle biopsy

COLPOSCOPY
LAPAROSCOPY
HYSTEROSCOPY
NOCTURNAL PENILE TUMESCENCE TESTS
DIGITAL RECTAL EXAMINATION
COMMON NURSING
TECHNIQUES
and
PROCEDURES
BREAST SELF EXAMINATION (BSE)
TESTICULAR SELF EXAMINATION (TSE)
MALE REPRODUCTIVE DISORDERS
PRIAPISM

sustained, painful erection that lasts 4 hours and is not associated with
sexual arousal.

ETIOLOGY & PATHOPHYSIOLOGY

High-flow, or arterial priapism

Veno-occlusive, or ischemic priapism

Conditions: sickle-cell anemia, leukemia, multiple sclerosis, and
metastatic tumors
If untreated: tissue fibrosis and impotence

ASSESSMENT
Clinical manifestations
1. Sustained erection
2. Erection is harder than normal
3. Penile discoloration
4. Penile pain
5. Urinary retention
6. Bladder distention
Diagnostic and laboratory tests: none
MANAGEMENT
Hydration
Treatment of the underlying condition
Aspiration and irrigation of corpus cavernosum & injection of dilute
vasoconstrictive agents
Surgery
Medication: analgesics and sedation, alpha-adrenergic drugs, and
intracavernosal injection of alpha-adrenergic drug (epinephrine or
phenylephrine)
NURSING MANAGEMENT
Administer analgesics and sedative promptly
Apply ice packs to penis as ordered
Facilitate voiding by helping the patient to a standing position, offering
fluids, and running water in sink
Report signs of urinary retention
Client education

assess clients understanding of treatment and causes of his condition

instruct client to seek medical attention early if priapism recurs

reassure client that sexual potency is usually maintained after shunting

procedure

instruct client to report difficulty voiding or painful urination

if surgery is performed, teach patient how to care for sutures

PHIMOSIS

constriction of the foreskin so that it cannot be retracted over the glans

penis

ETIOLOGY & PATHOPHYSIOLOGY

Congenital or related to chronic infections under foreskin (balanoposthitis),

leading to adhesions

Phimosis prevents hygiene, may lead to malignant changes and stenosis

of the meatus

Phimosis interferes with erection

ASSESSMENT
Clinical manifestations
non-retractable foreskin; retractable but cannot be returned
signs of infection: swelling, redness, purulent discharge, and pain
painful erections
decreased urinary flow, painful urination, and straining to void
Diagnostic and laboratory tests: none
MANAGEMENT

a dorsal slit on the foreskin necessary as an emergency measure

stretching of the foreskin by repeated retraction behind the glans

circumcision

Medication therapy: antibiotics & analgesics

NURSING MANAGEMENT

Administer antibiotics and apply warm soaks

Monitor clients urinary status, including his ability to void

Encourage fluids

Apply ice packs

Be aware that circumcision is usually indicated after obstruction and

infection are resolved.

Client education

If circumcision or dorsal slit is performed, teach client how to care for

incisions; a dry dressing may cover petrolatum gauze dressing, and may
need to be changed with each voiding; sutures will be absorbed.

Sexual intercourse is usually permitted 1 week after surgery

Instruct in personal hygiene measures, especially if circumcision is not

performed

Instruct client to report purulent drainage, redness, or edema of penis

ERECTILE DYSFUNCTION

inability to attain and maintain an erection sufficient to perform

satisfactory sexual intercourse.

synonymous with impotence ; may describe total inability to achieve

erection, or inconsistent erections, or ability to sustain only brief erections

ETIOLOGY & PATHOPHYSIOLOGY

Age-related changes

Veno-occlusive mechanism

Damage to arteries, smooth muscles and fibrous tissues by disease is the

most common cause of impotence

Prostate surgery

Many medications: antihypertensive agents or psychotropic agents

Psychogenic causes: depression, stress, fatigue, and fear of failure

Substance abuse

ASSESSMENT
Clinical manifestations

inability to have an erection

inability to maintain an erection

inability to penetrate for intercourse

Diagnostic and laboratory tests

blood profiles

nocturnal penile tumescence and rigidity (NPTR)

cavernosometry

intracavernous injections

psychological evaluation

MEDICAL-SURGICAL MANAGEMENT

external mechanical devices such as vacuum constriction device (VCD)

counseling and sex therapy

implantation of prosthetic devices

vascular reconstructive surgery

Medication therapy

Sildenafil (Viagra)

Self-administered intracavernous injections of papaverine or

prostaglandin E

Transdermal nitroglycerin paste

Alpostadil (Muse)

NURSING MANAGEMENT

Be aware that some clients feelings intense shame and have difficulty
discussing erectile dysfunction

Vacuum devices may be used, but they are clumsy and reduce
spontaneity

Client education

Provide list of support services for client and his sexual partner

Encourage discussion of alternate sexual practices

Teach the use of mechanical devices, such as vacuum constriction device

Discuss causes of clients sexual dysfunction that can be controlled,

Instruct in technique of intracavernous injection and use of topical

medications, if ordered

For clients who take sildenafil (Viagra):

take drug approximately 1 hour before sexual activity

do not use drug more than once a day

taking drug after a high-fat meal may delay the effect

discontinue drug and notify physician if chest pain or shortness of breath

occur with use

ORCHITIS

infection or inflammation of one or both of the testicles

ETIOLOGY & PATHOPHYSIOLOGY

Rarely a primary infection

Infectious organisms: bacteria, viruses, parasites, and fungi

Trauma or surgery

Orchitis related to mumps usually occurs 4 to 6 days after inflammation of

the parotid gland

Testicular abscesses, atrophy, fibrosis, and infertility may result from

orchitis

ASSESSMENT
Clinical Manifestations

fever, chills, and sudden pain on testes radiating to groin

Nausea and vomiting may accompany pain

Tenderness, redness, and warmth scrotal skin and edematous

Scrotal edema

(+) infections: mumps, urinary tract infection, or epididymitis

Diagnostic and Laboratory test: urine culture

MEDICAL-SURGICAL MANAGEMENT

Aspiration of fluid if hydrocele is present

Medication therapy: antibiotics, analgesics, antiemetics, anti-inflammatory

agents, and corticosteroids

NURSING MANGEMENT

Bedrest, scrotal elevation, and cold applications are used to decrease

inflammation of the testes

Administer antibiotic therapy based on causative organism

Monitor symptoms, including fever, pain, nausea, and vomiting

Explain medication therapy and the importance of finishing antibiotic

regime, even after symptoms resolve

If incision and drainage were done, teach dressing change procedure;

observe wound for redness and drainage; cleanse site gently with sterile
water or saline

Explain how to apply a scrotal support to provide elevation and secure

dressing

Teach client that exposure to mumps can result in sterility

EPIDIDYMITIS

infection or inflammation of the epididymis, a small structure that rests on

the testes

ETIOLOGY & PATHOPHYSIOLOGY

Most common intrascrotal infection, causes differ among younger and

older men

In younger men: caused by sexually transmitted urethritis caused by C.

trachomatis or N. gonorrhoeae

In older men: associated with urinary tract infection or prostatitis

Usually unilateral and caused by infection; complication of invasive urinary

tract procedures, such as catheterization or cystoscopy

ASSESSMENT
Clinical manifestations

Scrotum may be red or swollen

Urethral discharge (+)

Severe pain and tenderness in the groin and scrotum on affected side

Fever, nausea, and vomiting

Burning on urination, frequency, and urgency

duck waddle walk

DIAGNOSTIC & LABORATORY TEST

White blood cell count may be elevated (between 20,000 and

30,000/mm3)

Urinalysis shows increased WBC and presence of bacteria

Urine culture to identify organism

Scrotal ultrasound

Radionuclide scan

Aspiration of fluid from the epididymis

MEDICAL-SURGICAL MANAGEMENT
Medication therapy: antibiotics, antipyretics, analgesics, antiemetics, antiinflammatory drugs
NURSING MANAGEMENT

Enforce bed rest for 5 to 7 days or until pain-free

Elevate clients scrotum and provide cold packs to control pain and edema

Administer antibiotics as ordered; severe cases require IV antibiotics

Inspect the scrotal area for changes

Monitor temperature and provide antipyretics as prescribed

Offer fluids to replace fluid lost through diaphoresis and increased

metabolism

Client education

Teach the client to elevate scrotum with a towel or scrotal support to

reduce pain and edema; scrotal support may continue to be worn up to 6
weeks as necessary

Instruct client in applying intermittent cold compresses to the scrotum or

taking sitz baths

Instruct in the purpose, use, and potential adverse effects of antibiotics;

instruct client to take all of his medication, even if symptoms resolve

Encourage client to ask questions about effects of infection on his fertility

Explain cause of epididymitis and reasons for treatment; provide

information to prevent recurrence of infection

If caused by a sexually transmitted organism, advise client to avoid sexual

intercourse until his partner has been examined and treated

HYDROCELE

abnormal fluid collection within the layers of the tunica vaginalis, which
surrounds the testis

ETIOLOGY & PATHOPHYSIOLOGY

May be unilateral or bilateral

In adult: 20 epidimymo-orchitis, scrotal trauma, testicular cancer, or

hypoalbuminemia

Caused by increased production of fluid within the scrotum, or decreased

reabsorption of the fluid

Large hydrocele can impair physical activity and compromise blood supply
of the testis

Fluid characteristics depend on the cause; fluid associated with infection

may be cloudy and contain bacteria

ASSESSMENT
Clinical manifestations

Swelling of the testes

Discrepancies in size if the testes

Pain and tenderness of the testes

Diagnostic and laboratory tests: transillumination

MEDICAL-SURGICAL MANAGEMENT

No treatment is needed unless the mass increases in size and causes

discomfort

Aspiration via needle and syringe

Hydrolectomy (removal of fluid-sac)

Medication therapy: analgesics; sclerosing drug, such as 5 percent

tetracycline, injected into scrotal sac after aspiration of fluid

NURSING MANAGEMENT

Observe and monitor degree of scrotal edema

Treatment may be unnecessary, but provide supportive care for client

Fluid aspiration is most conservative treatment; provide information as

needed and allow client to verbalize his concerns and questions

Provide medication for pain control as needed

If hydrocelectomy is performed, make standard postoperative

assessments

Client education instructions after hydrocelectomy

Apply ice packs to scrotum as instructed

Change dressing daily and as needed; cleanse wound with soap and water

Reapply clean scrotal support

Keep scrotum elevated until edema resolves

Remind client that scrotal edema will disappear in 2 to 4 weeks

Avoid sexual intercourse and strenuous activity until directed by care

provider

Sutures are absorbable

VARICOCELE

a cluster of dilated veins from the pampiniform venous complex on the

spermatic cord that form a soft mass that can cause pain

ETIOLOGY &PATHOPHYSIOLOGY

Usually occurs in men between ages 15 and 40, with no known cause

Occasionally caused by defect in valves of the internal spermatic veins

Commonly associated with infertility, for unclear reasons; venous

enlargement may increase scrotal temperature, thus impairing sperm
production and motility

ASSESSMENT
Clinical manifestations

Dull ache or feeling of heaviness

Many men are asymptomatic

Dilated, tortuous veins may be palpated posterior to and above the

affected testes

Rush of blood can be felt in scrotum when client performs Valsalva

maneuver

Diagnostic and laboratory tests: Doppler ultrasonogram or venogram

MEDICAL-SURGICAL MANAGEMENT

Varicocelectomy

Embolization

Ligation of the spermatic vein

Medication therapy:
sclerosing agent, analgesic medications

NURSING MANAGEMENT

Apply scrotal support to relive clients discomfort

Prepare client for surgery as indicated; client usually returns home within a
few hours of surgery

Client education after varicocelectomy

Remain at home for about 5 days and avoid driving for 1 week

Avoid strenuous physical activity for 3 weeks

Follow healthcare providers instructions for resuming sexual activity

Instruct client that fertility may not be restored by the procedure, and
effects wont be known for several months

Remove soiled dressing and cleanse wound gently with soap and water

Wear scrotal support to decrease edema

TESTICULAR TORSION
twisting of the testes and spermatic cord
ETIOLOGY & PATHOPHYSIOLOGY

Compromised blood flow may lead to testicular ischemia and necrosis on

the affected side

Almost always occurs between birth and age 20

Cause is not well understood; possible related to elevated hormone levels

and abnormal attachment of the testicles to the scrotum

3 types of testicular torsion: intravaginal, extravaginal, & torsion of the

appendix testes

ASSESSMENT

Clinical manifestations

Pain localized to testes that radiate to the lower abdomen and groin; acute
on-and-off pain suggests intermittent torsion

Swollen, reddened and tender testis; the affected side is usually elevated

Tender epididymis

Negative cremasteric reflex on the same side of torsion

Nausea and vomiting

DIAGNOSTIC & LABORATORY TEST

urinalysis usually is normal

orchiogram or testicular scan shows diminished or obstructed blood flow

Doppler study identifies reduced blood flow

MEDICAL-SURGICAL MANAGEMENT
Detorsion
Orchiopexy
Orchioectomy
Medication therapy: analgesics
NURSING MANAGEMENT

Reinforce knowledge concerning the effect of surgery on sexuality

Teach the signs and symptoms of complications; bleeding, gaping incision,

purulent drainage form incision

Teach methods to control pain, such as ice bags and scrotal support

Remain at home for about 5 days and avoid driving for 1 week

Avoid strenuous physical activity for 3 weeks

Follow healthcare providers instructions for resuming sexual activity

TESTICULAR CANCER

unregulated growth of abnormal cells within the testicles

ETIOLOGY & PATHOPHYSIOLOGY

Exact cause is unknown, but risk factors include cryptorchidism,

maternal treatment with DES during pregnancy, mumps orchitis,
trauma, environmental factors, and age

Testicular cancer is the most common cancer among males age 15

to 35

90 percent of cancers arise from germ cell epithelium of the testes

Testicular cancer is usually slow-growing and localized, with good

prognosis

ASSESSMENT
Clinical manifestations

Presenting sign is most painless, hardened area or lump found during selfexamination

Dull ache in pelvis or scrotum

Testicular pain may occur with associated infection, necrosis, or

hemorrhage

Weight loss and fatigue

Metastatic signs: respiratory symptoms, GI disturbances, lumbar back

pain, lymphadenopathy, and gynecomastia

DIAGNOSTIC & LABORATORY TEST

Scrotal ultrasound; CT or MRI scan of chest, abdomen, and pelvis to rule

out metastasis

Intravenous pyelogram

Alpha fetoprotein (AFP) and beta unit of human chorionic gonadotropin

(HCG) Serum lactic acid dehydrogenase (LDH)

MEDICAL-SURGICAL MANAGEMENT

Orchiectomy and exploration of the adjacent area to identify the cancer

cell type and stage the disease

Radiation therapy

Chemotherapy

Lymphadenectomy

Medication therapy: chemotherapy with platinum-based combination

NURSING MANAGEMENT

Prepare client for screening tests to determine type of cancer and stage

Provide emotional support for client and family; respond to questions and
encourage client to express his feelings

Prepare client for surgery if indicated

Prepare client for chemotherapy after surgery and possible radiation

therapy, if cancer has spread to lymph nodes

After surgery: provide analgesics, ice packs, and scrotal support to control;
monitor for complications, such as bleeding or infection

Client education

Reinforce explanation of the type of cancer found, extent of the disease,

and plans for treatment

Stress importance of monthly testicular examination, because malignancy

may develop in remaining testis

Discuss the possibility of preserving sperm in the bank before surgery to

help relieve clients fears about infertility

Instruct client that orchiectomy should have no lasting effects on clients

sexual or productive function

Teach the signs of complications; bleeding, gaping incision, or purulent

drainage from incision

Teach methods to control pain, such as ice bags and scrotal support

Remain at home for about 5 days and avoid driving for 1 week

Avoid strenuous physical activity for 3 weeks

Follow healthcare providers instructions for resuming activity

Stress importance of follow-up, especially if retroperitoneal lymph nodes

were not surgically explored; client will need periodic physical
examinations, tumors markers, and CT scans of retroperitoneal nodes for 5
to 10 years after surgery

BENIGN PROSTATIC HYPERPLASIA

Overgrowth of cells in the prostate gland

ETIOLOGY & PATHOPHYSIOLOGY

Appears to be normal part of aging, but exact cause is unknown

Usually occurs as nodules in lateral or middle lobes of the prostate;

nodules grow and compress the normal prostatic tissue

Nodular enlargement also presses against the urethra and reduces its
diameter

Bladder muscles hypertrophy to compensate for resistance to urination;

fibromuscular bands or cord forms, along with bladder diverticula; client
has increased risk for bladder calculi and urinary retention

Ureters may dilate because of increased voiding pressure

Kidneys may become distended, leading to renal insufficiency

ASSESSMENT
Clinical manifestations

Many men have no symptoms

Classic symptoms: urinary frequency, nocturia, difficulty starting and

stopping urine stream, a weak stream, overflow dribbling, and feeling of
being unable to completely empty the bladder

Signs of cystitis, which may develop due to retained urine: painful

urination, pyuria, and fever

Digital rectal examination will reveal an enlarged prostate gland

DIAGNOSTIC & LABORATORY TEST

Routine analysis and culture

Acid phosphatase and prostate-specific antigen (PSA) to rule out prostatic

cancer

Urodynamic studies to determine degree of urinary obstruction

Post-voiding catheterization; residual urine of more than 100 mL is

considered high

Ultrasound

Cystoscopy

MEDICAL-SURGICAL MANGEMENT
Medication therapy: finasteride (Proscar), alphablockers
Non-surgical invasive management

Application of heat
Balloon inflation: balloon-tipped catheter is inserted through the urethra and
then is inflated to stretch the urethra where it is narrowed by the prostate
Laser ablation
Application of stents or coils in the prostatic urethra
Surgical intervention

Transurethral resection of the prostate (TURP)

Transurethral incision of the prostate (TUIP)

Suprapubic resection

Retropubic resection

Perineal resection

NURSING MANAGEMENT

Clients treatment is based on the severity of symptoms, degree of

prostate enlargement, and presence of complications (urinary retention
leading to urinary tract infections, pyelonephritis, and sepsis)

Monitor medication therapy if indicated

Encourage fluids (2, 000 to 3, 000 mL per day) to reduce risk for infection.

Suggest diet high in minerals: calcium, magnesium, zinc, and manganese

Client education

Avoid drugs that could cause urinary retention (anticholinergics)

Provide postoperative care following prostatectomy

The client who undergoes a TURP will have a three-way urinary catheter
and CBI

For the client with a retropubic prostatectomy, assess the abdominal

incision for signs of infection; urine in the dressing is not a normal finding
since the bladder is not accessed in this type of surgery

For the client with a suprapubic prostatectomy, monitor outputs from both
the suprapubic and urethral catheters

For the client with a perineal prostatectomy, preventing infection is vital

since the incision is in close proximity to the anus; avoid rectal
temperatures or enemas

Monitor urine character following prostatectomy

Clear to pale pink: normal during entire hospital course
Light red to red: normal or expected on day of surgery
and first postoperative day
Very dark red:
indicate venous bleeding or
inadequate CBI flow; check flow rate and vital signs
and tell the surgeon

Bright red: indicate arterial bleeding; check CBI

flow rate, check vital signs and notify surgeon
Blood clots: normal if they are only occasional, but
increase CBI flow rate to prevent catheter obstruction

Engaging in regular prostatic massage and sexual intercourse helps

decrease prostatic congestion

Limit the amount of fluids taken at one time to avoid distending the
bladder

Increase fluid intake to 2,000 to 3,000 mL daily to decrease risk for

bladder infection

Urinate at the first urge

Avoid drugs that can cause urinary retention: anticholinergics,

antidepressants, decongestants, and tranquilizers

PROSTATE CANCER

unregulated growth of abnormal cells in the prostate gland

ETIOLOGY & PATHOPHYSIOLOGY

Adenocarcinoma is most common type; high levels of testosterone may

play a role

Usually begins in peripheral tissue on back and sides of the gland

Metastasis via lymph and venous channels is common; bony tissue is

major site of distant metastasis-especially pelvic bones and spine

Is seen predominantly over 40 years of age

ASSESSMENT
Clinical Manifestations

Early stages often show no symptoms; tumor may be found during digital
prostate exam

GU: dysuria, frequency, reduced force of stream, hematuria, nocturia,

abnormal prostate (DRE)

MS: back pain, migratory bone pain, bone or joint pain

Neurologic: nerve pain, muscle spasms, bowel or bladder dysfunction,

bilateral weakness of lower extremities

Systemic: fatigue and weight loss

Diagnostic and Laboratory test:

Prostate-specific antigen (PSA) levels, transrectal ultrasonography
(obtained if PSA results are abnormal), tissue biopsy, bone scan; MRI, or CT scans
to detect metastasis.
MEDICAL-SURGICAL MANAGEMENT

Hormone therapy

Radiation therapy

Brachytherapy (radioactive seeds implanted in the prostate)

Prostatic cryosurgery

Surgery

Orchiectomy

Radical procedures

Suprapubic prostatectomy

Retropubic prostatectomy

Perineal prostatectomy

Homium laser

Medication therapy: estrogen therapy or luteinizing hormone antagonist

(Lupron) given to slow rate of growth and extension of tumor

NURSING MANAGEMENT

Treatment is complex and depends on stage of cancer, clients age and

general health

Encourage annual prostate examination for men 40 years old and above

Preoperative and postoperative care of the client undergoing prostatic

surgery

Client Education

Assess clients knowledge about his illness and treatment plan; reinforce
knowledge and option questions

Teach methods to deal with urinary incontinence, which occurs temporarily

after surgery, although it could be permanent if bladder sphincters have
been permanently damaged

Care of the urinary catheter

Teach methods of pain control

Instruct about the impact of therapy on sexual function (temporary or

permanent impotence, permanent infertility after radical prostatectomy)

Refer client to support groups

Stress the importance of follow-up tests for recurrence of the disease

Teach signs of spinal cord compression (back pain and lower extremity
weakness), because of high incidence of metastasis to spinal cord

Instruct in activity levels as prescribed

FEMALE REPRODUCTIVE DISORDER

PREMENSTRUAL SYNDROME

group of symptoms preceding the monthly menses that regress or

disappear during menstruation

ETIOLOGY & PATHOPHYSIOLOGY

Affects women of all ages, races, and cultures

Believed to be related to hormonal changes such as altered estrogenprogesterone ratios, increased prolactin levels, and rising aldosterone
levels during luteal phase of menstrual cycle (7 to 10 days before onset of
flow)

Increased aldosterone causes sodium retention and edema

Decreased monoamine oxidase in brain causes depression

Decreased serotonin causes mood swings

Produces multisystem effects that vary with each client and from month to
month

ASSESSMENT
Clinical manifestations
1. Multisystem effects

Neurologic: syncope, vertigo, dizziness, paresthesia, headache,

inability to concentrate, depression, irritability, anxiety, mood
swings, anger, aggressive behavior

Sensory: conjunctivitis, visual disturbances

Cardiovascular: bruising, palpitations

Urinary: cystitis, oliguria

Gastrointestinal : constipation, nausea, vomiting

Musculoskeletal : backache, pelvic stiffness

Integumentary: acne, herpes recurrence, urticaria

Immune system: increase susceptibility to infection, asthma,

increase allergic reactions

Metabolic Processes: breast tenderness, edema, transient weight

gain, food cravings

2. In primary dysmenorrheal, excess prostaglandins cause uterine muscle fibers

to contract, producing uterine ischemia and painful cramps
Diagnostic and laboratory tests
organic causes are ruled out first; there are no definitive diagnostic tests for PMS
MEDICAL-SURGICAL MANAGEMENT

Pharmacologic management: oral contraceptives to suppress

ovulation in severe cases; NSAIDs to relieve cramping; diuretics to relieve
bloating; and selective serotonin reuptake inhibitors, such as flouxetine
(Prozac), sertraline (Zoloft), paroxetine (Paxil) to manage mood swings

Nonpharmacological management : modifications in diet, establishing

an exercise plan, and stress management

NURSING MANAGEMENT

Nursing care focuses on teaching self-care and relieving symptoms

Ask the client to keep menstrual log on daily basis for 1 to 4 months,
recording symptoms and their relationship to the menstrual cycle

Evaluate severity of symptoms and their effects on clients life

Reduce sodium intake to minimize fluid retention

Diet should be high in complex carbohydrates with limited simple sugars

and alcohol to minimize reactive hypoglycemia

Restrict caffeine to reduce irritability

Increase intake of calcium, magnesium, and vitamin B6

Client education

Teach measures to relieve pain

Instruct client to use relaxation techniques, get regular physical exercise,

and eat a well-balanced diet

Encourage client to keep a diary of PMS symptoms and methods that

produce relief

Explore self-care measures to help with mood alterations, including stress

identification

DYSMENORRHEA

pain associated with menstruation

In primary dysmenorrheal, excess prostaglandins cause uterine muscle

fibers to contract, producing uterine ischemia and painful cramps

Onset is just before or at beginning of first menstrual flow lasts from a

few hours to several days

Childbirth tends to reduce severity

Secondary dysmenorrheal is related to underlying conditions that

cause scarring or injury to reproductive (endometriosis, fibroid tumors,
PID, and ovarian cancer)

ASSESSMENT
Clinical manifestations
sharp pain located in lower abdomen, radiating to lower back, groin, or thighs
headache, nausea, anorexia, bloating, diarrhea, faintness, or fatigue
DIAGNOSTIC & LABORATORY TEST

Pelvic examination

FSH and LH levels

Progesterone and estradiol levels

Thyroid function tests

CT or MRI

Laparoscopy

Dilatation and curettage (D&C)

MEDICAL-SURGICAL MANAGEMENT

Pharmacological management: either nonprescription prostaglandin

inhibitors or nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief
and oral contraceptives in severe cases to inhibit ovulation

stress reduction, exercise, dietary

NURSING MANAGEMENT

Provide information on use of relief measures

Recommend reducing intake of sodium, sugar, caffeine, and alcohol

Ask client to describe type, degree, time of onset, and duration of pain

Assess characteristics of menstrual cycle

Assess for presence of underlying problems, such as STD, PID, fibroid

tumors, ovarian cancer

Ask client about relief measures she has tried

Note physical factors that may contribute

Client Education

provide information that in most cases the disorder is benign in nature

teach relief measures, such as regular exercise, good posture, balanced

diet and good hygiene; waist-bending exercises before onset of
menstruation can help

instruct client to avoid constipation, which creates abdominal pressure

use a heating pad to help reduce pain

instruct client that increased intake of protein, calcium, magnesium, and

vitamin B6 may help relieve symptoms

ABNORMAL UTERINE BLEEDING

vaginal bleeding that is painless but abnormal in amount, duration, or

time of occurrence

ETIOLOGY & PATHOPHYSIOLOGY

Primary amenorrhea: absence of menstruation; caused by structural

abnormalities, hormonal imbalances, polycystic ovary disease, or
imperforate hymen

Secondary amenorrhea: absence of menstruation in a previously

menstruating client; caused by anorexia nervosa, excessive athletic
activity, hormonal imbalance, or ovarian tumors

Oligomenorrhea: scant menses; usually related to hormonal imbalance

Menorrhagia: excessive or prolonged menstruation; related to thyroid

disorders, endometriosis, PID, ovarian cysts, or uterine fibroids

Metrorrhagia: bleeding between menstrual periods; caused by hormonal

imbalance, PID, cervical or uterine polyps or cancer; early evaluation for
cancer is important with metrorrhagia

Postmenopausal bleeding: caused by endometrial polyps, endometrial

hyperplasia, or uterine cancer; early evaluation for cancer is important

ASSESSMENT
Clinical manifestations : abnormal amount of vaginal bleeding
Diagnostic & laboratory tests

CBC to rule out other causes

Endocrine studies, including thyroid hormones, to rule out cause

HCG levels

Pelvic ultrasound

Hysteroscopy to detect uterine abnormalities

Endometrial biopsy

MEDICAL MANAGEMENT

Hormonal therapy

Therapeutic dilatation & curettage, or scraping the uterine wall to correct

excessive bleeding

Endometrial ablation

Hysterectomy, or removal of the uterus

Medication therapy: oral iron supplements

NURSING MANAGEMENT

Assess characteristics of clients menstrual cycle

Evaluate symptoms

Assess clients coping strategies and psychological support system

Assist client in dealing with self-esteem disturbances and anxiety

Assist client through the diagnostic and treatment processes

Teach the physiology of normal menstruation

Instruct client in purpose, benefits, and risks of diagnostic tests and

treatments

Discuss results of all tests and examination and encourage

questions

Educate client about normal hygiene during menstruation

Teach measures to reduce discomfort associated with menstruation

or treatments

Emphasize the need to report episodes of excessive bleeding or

postmenopausal bleeding due to the risk for cancer

UTERINE PROLAPSE

downward displacement of the uterus into the vaginal canal

First-degree Prolapse: less than half uterus extends

into vagina

Second-degree Prolapse: descent of entire uterus into

vaginal canal

ETIOLOGY & PATHOPHYSIOLOGY

May be congenital or acquired

Usually related to weakened pelvic musculature caused by stretching of

supporting ligaments during pregnancy and childbirth

Risk factors: unrepaired lacerations from childbirth, rapid deliveries,

multiple pregnancies, congenital weakness, loss of elasticity and muscle
tone with aging, and chronic coughing

Prolapse is often accompanied by cystocele or rectocele

ASSESSMENT

Clinical manifestations

Lump protruding from vagina; typically painless and has increased

in size for months or years; usually worse with standing or straining

Discomfort in lower abdomen, or pressure and heaviness in vaginal

area; client may complain of low backache with standing

Difficulty in defecation due to rectocele

Difficulty urinating due to cystocele

Urinary incontinence

Pain with intercourse

Signs of infection, chafing, ulceration, and bleeding from exposed

uterus in third-degree prolapse

Diagnostic & laboratory tests:

pelvic examination
MEDICAL-SURGICAL MANAGEMENT

Kegel exercises

Insertion of vaginal pessary, a donut-shaped ring placed in the vagina to

provide uterine support

Vaginal hysterectomy

NURSING MANAGEMENT

Advise client about nonsurgical techniques to manage prolapse

Discuss use of pessary, device inserted into vagina to provide temporary

support

Discuss treatment options and prepare client for hysterectomy, which is

treatment for third-degree prolapse

Teach ways to deal with stress incontinence, which may accompany

uterine prolapse

Client education

Instruct client in Kegel exercises to reduce stress incontinence

Discuss treatment options and prepare client for surgery, which is

main treatment for rectocele and cystocele

Describe what to expect in the postoperative period

Explain to client that both colporrhaphy procedures shorten the

overall length of the vagina and may result in discomfort during
sexual intercourse

VULVITIS

inflammation or infection of the vulva

ETIOLOGY & PATHOPHYSIOLOGY

Skin of the vulva is prone to inflammation from mechanical or chemical

irritation, due to its location

Causes include: tight-fitting clothes; exposure to urine, fecal material,

vaginal discharge, and glandular secretions; chemical irritants, such as
soap, feminine hygiene spray, powder, vaginal lubricants, etc.

ASSESSMENT
Clinical manifestations

Itching as the cardinal symptom

Burning sensation aggravated by urination or defecation

Tissue appear red and swollen; there may be abrasions where

client has scratched

Vaginal discharge may be present with vaginitis

DIAGNOSTIC & LABORATORY TEST

Culture for discharge

KOH analysis, wet smear analysis, and Gram stain

Urinalysis and urine culture

Serologic testing

MEDICAL-SURGICAL MANAGEMENT

Medication therapy: topical creams to relieve inflammation and

antibiotics if infection is present

NURSING MANAGEMENT

Ask client about personal habits that could contribute to inflammatory

process

Identify type of infection through observations or cultures

Provide appropriate pharmacologic treatment for infection and

inflammation

Give soothing compresses or colloidal baths

Apply medicated creams

Client Education

Teach client how to properly clean the vulva

Teach client to avoid tight-fitting clothes, wear 100% cotton

underpants, and wear knee-high or thigh-high stockings instead of
pantyhose when possible

Avoid strong laundry soaps, talcum powder, perfumed soap,

scented toilet paper, and deodorant sprays

To kill yeast in underwear, soak in half-strength bleach for 20

minutes before washing

Instruct in use of comfort measures, such as sitz baths, cool or

warm compresses, and topical creams

CERVICAL CANCER

unregulated growth of abnormal cells in the cervix

ETIOLOGY & PATHOPHYSIOLOGY

Most common cancer of the reproductive system

Usually seen in clients between ages of 30 and 50

May become invasive and spread to tissue outside the cervix, fundus of
the uterus, and the lymph glands

Treatment depends on extent of disease

Squamous cell carcinoma accounts for 90 percent of cervical cancers; they

have gradual onset; spread by direct invasion of accessory structures

ASSESSMENT
Clinical Manifestations

thin, watery, blood-tinged vaginal discharge, which may go

unnoticed by client

painless bleeding between periods, often seen after intercourse,

douching, or other contact

late symptoms: referred pain in back and thighs, hematuria, bloody

stools, anemia, and weight loss

early diagnosis is critical, because cervical cancer can be cured in

early stages

DIAGNOSTIC & LABORATORY TEST

Cervical pap test; abnormal results call for repeat test, colposcopic exam
of cervix, and tissue biopsy; diagnosis is based on biopsy results
therapeutic management: chemotherapy, radiation therapy

MEDICAL-SURGICAL MANAGEMENT

Chemotherapy for unresponsive tumors and nonremovable tumors

Radiation therapy

Surgery

Medication therapy: analgesic for pain control

NURSING MANAGEMENT

Assist client in dealing with psychologic effects of illness; provide

information and emotional support

Explore treatment options with client and family

Develop strategies for pain control

Maintain skin and tissue integrity during radiation treatment and following
surgery

Observe for fistula formation between vagina and the bladder or rectum, a
possible complication of radiation therapy

Recommend a high-carbohydrate, high-protein diet

Client education

Explain and discuss all diagnostic tests and treatment, allowing

client time to express her feelings and ask questions

Teach wound and skin care if surgery or radiation therapy are

performed

Explain that 66 percent of all women with cervical cancer survive

for 5 years or more

Emphasize the importance of regular screening exams and followup after treatment is completed

OVARIAN CANCER

unregulated growth of abnormal cells in the ovaries

ETIOLOGY & PATHOPHYSIOLOGY

The most lethal of gynecologic cancers; etiology not understood

Is often asymptomatic, leading to late diagnoses; usually detected by

chance, not thorough screening

Risk increases after age 40

May involve one or both ovaries; staged according to tissue involvement

STAGES of OVARIAN CANCER

Stage I limited to ovaries

Stage II pelvic extension

Stage III metastasis outside pelvis or positive lymph nodes

Stage IV distant metastasis

ASSESSMENT
Clinical manifestations

Symptoms are rare until extensive tumor growth is present

Feeling of pelvic pressure or heaviness, vague abdominal

discomfort, dyspepsia, bloating, constipation, urinary frequency,
and increased abdominal size

Palpable hard, fixed, firm mass in the area of the ovaries during
pelvic exam

DIAGNOSTIC & LABORATORY TEST

No definitive diagnostic tool is available; diagnosis is made during surgery

(exploratory laparotomy)

CA125 antigen level is sometimes useful in detecting ovarian cancer;

CA125 is a tumor marker

MEDICAL-SURGICAL MANAGEMENT

Surgery

Radiation therapy

Chemotherapy may be used to achieve remission, but is not a cure

NURSING MANAGEMENT
Explore treatment options with client and family
Assist client in dealing with psychologic effects of illness; provide
information and emotional support
Develop strategies for pain control
Maintain skin and tissue integrity during radiation treatment and following
surgery
Client education
Explain and discuss all diagnostic tests and treatments, allowing client
time to express her feelings and ask questions
Teach wound and skin care if surgery or radiation therapy is performed
Emphasize the importance or regular screening exams and follow-up after
treatment is completed
Teach client not to ignore vague symptoms, such as indigestion, nausea,
or urinary frequency
BREAST CANCER

unregulated growth of abnormal cells in breast tissue

ETIOLOGY & PATHOPHYSIOLOGY

Cause unknown, but many risk factors influence development
Female gender and white/Caucasian race
Family history of mother or sister with breast cancer
Medical history of cancer of other breast, endometrial cancer, or atypical
hyperplasia
Menarche before age 12 (early) or menopause after age 50 (late)

First birth after 30 years of age, oral contraceptive use (early or

prolonged), prolonged use of estrogen replacement therapy

Lifestyle factors: high-fat diet, obesity, high socioeconomic status,

breast trauma, smoking, ingesting more than 2 alcoholic drinks
daily

Exposure to radiation through chest X-ray, fluoroscopy

Begins as single transformed cell and is hormone-dependent; does not

develop in women without functioning ovaries who never received
hormone replacement therapy
Most often occurs in ductal areas of breasts
Noninvasive: does not penetrate surrounding tissues; may be ductal or
lobular; usually diagnosed through mammogram or nipple discharge
Invasive: penetration of tumor into surrounding tissue; five types of
invasive cancers, with only slight differences in prognosis
Staging depends on size of tumor, lymph node involvement, and
metastasis to distant sites
70 percent of clients with Stage I tumors survive for ten years with therapy
ASSESSMENT
Clinical manifestations
Lump in upper outer quadrant of breast, usually nontender, but may be tender
Dimpling of breast tissue surrounding nipple, or bleeding from the nipple
Asymmetry, with affected breast being higher
Regional lymph nodes swollen and tender
DIAGNOSTIC & LABORATORY TEST
Mammography, Ultrasonography, MRI, PET, issue biopsy, sentinel node
biopsy (uses radionuclides to locate sentinel node for removal and analysis
rather than a chain of nodes)
MEDICAL-SURGICAL MANAGEMENT
Surgery
Radiation therapy
Chemotherapy
Hormonal therapy
Medication therapy: Tamoxifen (Novadex) interferes with estrogen
activity for treating advanced breast cancer, and chemotherapy when
axillary nodes are involved
NURSING MANAGEMENT
Explore treatment options with client and family; prepare client for
treatment, which is based on stage of disease

Radiation therapy
Various types of mastectomy may be performed:
Segmental mastectomy or lumpectomy
Simple mastectomy
Modified radical mastectomy
Radical mastectomy
Breast reconstruction

Assist client in dealing with psychologic effects of illness; provide

information and emotional support, including information about breast
reconstruction surgery
Maintain and tissue integrity during radiation treatment and following
surgery
Client Education
Explain and discuss all diagnostic tests and treatments, allowing time to
express her feelings and ask questions
Review information about mastectomy surgery and what to expect
afterward
Teach wound care if surgery is performed, including care of short-term
wound drains
Teach techniques for proper skin care if radiation therapy is performed
Encourage client to meet other women whove undergone treatment, if
appropriate
Teach client how to protect affected arm and hand from infection and
injury if lymph nodes are removed during mastectomy
Teach postoperative exercises and self breast-examination
Teach self-care during radiation and chemotherapy treatments
Emphasize the importance of regular screening exams and follow-up after
treatment is completed
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