Lewis: Medical-Surgical Nursing, 9th Edition

Chapter 51

Nursing Assessment: Reproductive System

KEY POINTS

STRUCTURES AND FUNCTIONS OF MALE AND FEMALE REPRODUCTIVE

SYSTEMS
The primary roles of male reproductive system are production and transportation
of sperm, deposition of sperm in female reproductive tract, and secretion of hormones.
The major gonadal hormone of men is testosterone, which is produced by
interstitial cells within the testes. Testosterone is responsible for development and
maintenance of secondary sex characteristics and spermatogenesis.
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.
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.
In women, follicle-stimulating hormone (FSH) production by the anterior
pituitary stimulates growth and maturity of ovarian follicles. Mature follicle produces
estrogen, which in turn suppresses the release of FSH. In men, FSH stimulates
seminiferous tubules to produce sperm.
In women, luteinizing hormone (LH) from the anterior pituitary contributes to
ovulation by stimulating follicles to complete maturation and undergo ovulation. In men,
LH is responsible for the production of testosterone.
Estrogen and progesterone are produced by the ovaries.
o Estrogen is essential to the development and maintenance of secondary
sex characteristics, proliferative phase of menstrual cycle immediately after
menstruation, and pregnancy uterine changes.
o Progesterone is also involved in body changes of pregnancy.
Menarche is the first episode of menstrual bleeding, indicating that a female has
reached puberty. This usually occurs at 12 to 13 years of age, but may range from 9 to 16
years of age.
The major functions of ovaries are ovulation and secretion of hormones. These
functions are accomplished during the menstrual cycle.
o The length of the menstrual cycle generally ranges from 20 to 40
days. It is mediated by the hormonal activity of the hypothalamus, pituitary gland,
and ovaries.
o If fertilization occurs, high levels of estrogen and progesterone
continue to be secreted because of 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.
Menopause is the physiologic cessation of menses associated with declining
ovarian function. It is usually considered complete after 1 year of amenorrhea.
The sexual response is a complex interplay of psychologic and physiologic
phenomena influenced by a number of variables, including daily stress, illness, and crisis.
o Changes that occur during sexual excitement are similar for men and
women.
o Sexual response can be described in terms of the excitement, plateau,
orgasmic, and resolution phases.
GERONTOLOGIC CONSIDERATIONS: EFFECTS OF AGING ON REPRODUCTIVE
SYSTEM
In women, aging changes include a reduction in circulating estrogen along
with an increase in androgens in postmenopausal women. These changes are associated
with breast and genital atrophy, reduction in bone mass, and increased rate of
atherosclerosis.
Aging changes in men include an increase in prostate size, decreased
testosterone level and sperm production, decreased scrotum muscle tone, and size and
firmness of the testicles. Erectile dysfunction and sexual dysfunction can occur as a result
of these changes.
ASSESSMENT OF MALE AND FEMALE REPRODUCTIVE SYSTEMS
You have an important role in providing accurate and unbiased information about
sexuality and age. 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 Be sensitive, ask gender-neutral questions, and maintain awareness of
patients culture and beliefs.
o It is helpful to begin with the least sensitive information (e.g., menstrual
history) before asking questions about more sensitive issues such as sexual
practices or sexually transmitted infections.
Women should have a complete menstrual, obstetric, and gynecologic history
taken, including oral contraceptive use.
o 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 the reproductive system.
o Detailed history data are used to detect gynecologic concerns.
Physical examinations involve the following:
o Examining male external genitalia: inspection and palpation of pubis,
penis, scrotum and testes, inguinal region and spermatic cord, anus, and prostate.
o Examining 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 OF REPRODUCTIVE SYSTEMS
 Serum hCG is used to diagnose pregnancy.
Prolactin assay is used for patients with amenorrhea.
Serum progesterone and estradiol can help in ovarian function assessment,
particularly for amenorrhea.
Hormonal blood studies are essential for a fertility workup.
Several tumor antigens are measured to assist in detecting and monitoring the
effectiveness of therapy for reproductive system malignancies.
Blood serology tests, cultures, and smears are frequently used to detect the
presence of a sexually transmitted infection.