Download The Menstrual Cycle

The Reproductive System
Ana Corona, MSN, FNP-C
Nursing Instructor
February 2009
Sydney Cancer Center, Adams Anatomy Images, The McGraw-Hill Companies,
WebMD Corporation, Mayo Foundation. Foundations of Nursing, 2nd ed. L.
White.
More reviews: Nurseana.com
Functions of the Female Reproductive System
Produce ovum, Maintain the fertilized egg, Maintain the embryo
Structures:
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Ovaries: Have 2 main functions: Ovulation and production of hormones
(estrogen & progesterone)
Uterus: is peared shape and measures approx 3 inches. Receives and nurtures
embryo during development
Fallopian Tubes: convey ovum to uterus
Fimbrae: fingerlike projections lined by tiny hair like cilia that assist the ovum
to travel to the uterus.
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Vagina: receives sperm & serves as birth canal for the fetus
Cervix: lower part of the uterus
Perimetrium: Outer layer of the uterus
Myometrium: middle layer of uterus. Muscle
Endometrium: inner layer of the uterus
Structures of the Female Reproductive System
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Mons Pubis: Fatty
tissue on pubic
symphysis.
Labia Majora: Protects
external genital
structures
Labia Minora: Protects
vaginal and urethral
openings
Clitoris: Erectile tissue
and is richly supplied
with nerves
Bartholin Glands:
small pea-sized glands.
Produce a mucoid
secretion to lubricate
the vagina and vulva.
Skene’s Glands:
Secrete mucus.
"On the Rag"
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Originated sometime between 19th to 20th
century.
When a woman was menstruating, she was
“on the rag,”
Each woman had a supply of rags for specific
use during menstruation.
Layer rags together, use pins to attach the
rags to their panties.
Women would wash the rags and hang them
out to dry.
Menstrual Cycle
Normal cycle length is considered 28
days
 varies from female to female
 Bleeding as a result of menstruation
lasts 2 to 7 days on average
 An average loss of 20 to 80mL of
blood.
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Three Phases during Menstrual Cycle
1.
2.
3.
Proliferative Phase:
Preparing for Ovulation endometrium begins to
grow after menstruation.
Secretory Phase:
Preparing for Implantation
- endometrium is
becoming ready for the
implantation of a
blastocyst.
Menstrual Phase: If no
implantation occurs, the
endometrium breaks
down and is discharged
in menstruation.
Proliferation Phase: Preparing….
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Proliferation Phase starts in the anterior pituitary
gland with the release of FSH (follicle stimulating
hormone)
FSH goes to the ovaries and causes the ovarian
graafian follicle (OVUM) to develop/mature & ripen.
Follicle begins to mature - releases ESTROGEN
Estrogen causes the uterine lining to thicken in
preparation of the ovum (egg) and causes the ovum to
ripen and enlarge.
When estrogen levels get high enough they cause the
release of LH or luteinizing hormone
Secretory Phase: Ovulation
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Secretory Phase---extends from the day of ovulation to
about 3days before the next menstrual period.
LH causes the release of the ovum or OVULATION
The follicle pops and the ovum comes oozing out
causing a crater on the side of the ovary to be formed
The “crater” that is left on the side of the ovary oozes
PROGESTERONE.
After ovulation, a large amount of progesterone is
produced.
Progesterone causes the uterine lining to thicken in
preparation for implantation of a fertilized ovum.
Menstrual Phase: NO BABY
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No fertilization of the ovum occurs in the
fallopian tubes and the ovum deteriorates.
If fertilization and implantation does not occur,
progesterone and estrogen levels decrease
The hypothalamus secretes gonadotropinreleasing hormone (GnRH) that stimulates the
anterior pituitary to secrete FSH
Menstruation begins which marks the first day
of the new menstrual cycle.
Rising levels of FSH trigger the beginning of
the next phase, called the proliferative phase
The Ovarian Cycle
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The normal ovulatory cycle is divided into two
phases called the follicular and luteal phases.
Different levels of hormones are released.
Follicular Phase: is initiated from the day
bleeding stops and finishes with a midcycle
surge of LH.
Luteal Phase: this is initiated with the midcycle surge of LH which coincides with
ovulation and ends with the first day of onset
of the period.
Menstrual Disorders
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Dysmenorrhea–painful menstruation.
Amenorrhea–absence of menstruation.
Polymenorrhea–menstrual cycles of less than
21 days.
Oligomenorrhea–diminished menstrual flow
that is not amenorrhea.
Interventions based on cause of disorder.
Amenorrhea Cessation of Menstruation
2 Types Primary & Secondary
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Primary
Absence of
menstruation in a
woman by the age
of 16.
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Secondary
Menstruation has
stopped for 3 months
in a woman with a
history of regular
cyclic bleeding, or 6
months in a woman
with a history of
irregular periods.
Dysmenorrhea
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Severe uterine pain during menstruation.
Pain - sharp, throbbing, dull, burning, shooting
Nausea and vomiting, diarrhea, headache, fainting,
and fatigue.
Heavy blood loss, known as menorrhagia.
Release of prostaglandins and other inflammatory
mediators in the uterus is thought to be a major
factor in primary dysmenorrhea.
Metrorrhagia, Menorrhagia
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Metrorrhagia: heavy bleeding between
periods, or bleeding unrelated to the
menstrual period.
Menorrhagia: menstrual bleeding that lasts
more than 7 days or bleeding that is much
heavier than usual for the individual.
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Hormonal imbalance
Chronic medical problems - as thyroid disorders,
diabetes, and blood-clotting disorders.
Diagnostic Tests: Laboratory,
Pelvic/transvaginal ultrasound
Treatment: Hormonal therapy
Premenstrual Syndrome - PMS
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PMS often occurs after ovulation.
Over 150 symptoms have been reported that
have been related to PMS.
Treatment includes counseling, medications,
dietary changes, regular exercise.
Climacteric
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Menopause
Change of life
Cessation of menstruation
Decreasing level of ovarian hormone production
affects women in variety of ways
Depression, hot flashes, insomnia, anxiety
Treatment includes- Hormone Replacement Therapy
(HRT) estrogen replacement therapy, Medications:
Conjugated equine estrogen/ Premarin, Transderm
estrogen system/Estraderm
Controversy – increased risk for endometrial cancer
in postmenopausal women
dietary changes, exercise.
Papanicolaou test
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A Pap smear is an
examination under the
microscope of cells
scraped from the cervix
The Pap smear can
detect cancerous or
precancerous
conditions of the cervix
Cervical Cancer
Screening Guidelines
Trichomoniasis Vaginalis
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Protozoan (parasite)
infection
STD
Yellow/gray, greenish
vaginal discharge
Itching and burning
Vaginal culture or wet
mount
Treatment: Flagyl
Partner tx
Strawberry cervix
Candidiasis Vaginitis (yeast)
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White thick curdy discharge
Vaginal itching, burning
Vaginal culture, wet mount
Treatment: vaginal creams Minonazole, Monistat-3,
Monistat-7, Nystatin
Oral – diflucan
Prevention: avoid tight
fitting clothes.
Antibiotic therapy or
hormonal
Yogurt
No douching
Chlamydia Trachomatis
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STD
Vaginal burning, dysuia
Vaginal discharge or
bleeding
Pelvic pain
Dysparunia
Vaginal or urine
chlamydia culture
Treatment:
azythromycin
Partner treatment
Bacterial Vaginosis
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Gardnerella vaginalis
Milky thick discharge
Fishy odor
Itching and burning
Vaginal culture or wet
mount
Treatment:
metronidazole or
clindamycin (vaginal gel
or pills).
Partner treatment
recommended
Cervical Cancer
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The most preventable
gynecological cancer,
with regular Pap smears.
Most common signs:
abnormal bleeding, odor,
pain in lower back, groin,
difficulty in voiding,
hematuria, rectal
bleeding.
Treatment includes
varying degrees of
surgery, radiation, and
palliation
Carcinoma In Situ
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(CIS) is pre-malignant
cells
Abnormal cells remain
with in the cervix
Have not yet spread to
other organs
Colposcopy
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Diagnostic procedure to
examine and view the
cervix and the tissues of
the vagina and vulva.
Colposcope allows of
enlarged abnormal
areas to be visualized
Directed biopsies can be
obtained for further
pathological
examination.
Endometrial Cancer
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Cancer of the lining of the uterus.
Symptoms do not appear until the cancer is
advanced.
Routine Pap smears, pelvic examinations not
adequate for early diagnosis.
Treatment: radiation, chemotherapy, and/or
surgery.
Ovarian Cancer
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Originates in epithelial
tissue of ovary
and does not produce
symptoms until it is in
an advanced,
inoperable stage.
Treatment includes a
combination of surgery,
radiation,
chemotherapy,
immunotherapy, and
palliation.
Endometriosis
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Growth of
endometrial tissue
outside the uterus
within the pelvic
cavity.
Cause is unknown
Symptoms include
low backache, painful
intercourse, a feeling
of heaviness on the
pelvis, and spotting.
Treatment: danazol
and/or surgical
removal of the
lesions.
Dilation and Curettage
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The procedure may be
performed in the hospital or in
a clinic using general or local
anesthesia.
The vaginal canal is held open
by a speculum and the
opening to the uterus.
The cervical canal is dilated
using a metal rod and a
curette is then passed through
the canal into the uterine
cavity.
The endometrium is scraped
away and the tissue is
collected for examination.
Fibroid Tumors
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Benign tumors growing
in or on uterus.
Symptoms include
menorrhagia, increasing
pelvic pressure,
dysmenorrhea,
abdominal enlargement,
and constipation.
Treatment: periodic
reexamination,
myomectomy, or
hysterectomy.
Fistula
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An abnormal
connection
between an
organ, vessel, or
intestine and
another
structure.
Result of injury,
surgery,
infection or
inflammation
Structural disorders of the female reproductive system.
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Urethrocele–downward
displacement of the
urethra into the vagina.
Rectocele–anterior
displacement of the
rectum into the
posterior vaginal wall.
Cystocele
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Cystocele–downward
displacement of the bladder
into the anterior vaginal wall.
Walls weakens between
bladder and vagina
Bladder herniates into the
vagina.
Symptoms: urine leakage,
UTI, pressure.
Treatment: avoidance of
heavy lifting or straining.
A pessary device
Large cystoceles may require
surgery
Prolapsed uterus
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Downward displacement of
the uterus into the vagina.
Factors – multiple vaginal
deliveries, large infant,
Increasing age, frequent
heavy lifting. A number of
conditions, constipation, and
obesity.
Symptoms - Urinary
complaints including urinary
incontinence frequency,
urgency, pain with
defecation, constipation, or
incontinence, sexual
complaints, including pain
with intercourse.
Dx: Examination, Ultrasound,
MRI
Tx: kegel exercise, pessaries,
surgery
Colporrhaphy
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Surgical procedure
Surgical intervention for
both cystocele and
rectocele.
General or local anesthesia.
A speculum is inserted into
the vagina to hold it open
during the procedure.
An incision is made into the
vaginal skin.
The vaginal skin is
separated from the fascia
and the defect is folded
over and sutured (stitched).
Culdoscopy
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Transvaginal hydrolaparoscopy
or THL)
To detect problems such as
endometriosis or scar tissue
which can both affect fertility.
Narrow telescope inserted thru
the back of the vagina
To check the outside of the
uterus, fallopian tubes and
ovaries.
Saline is instilled into the pelvis.
A blue dye instilled to visualize
fallopian tube patency
No scars
Local anaesthesia.
Toxic Shock Syndrome
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Toxic shock syndrome (TSS) life-threatening
illness.
Staphylococcus aureus enters bloodstream.
Common tampon (super-absorbent) users.
Temp of 102ºF or greater, vomiting, diarrhea,
hypotension, flulike symptoms, flat red rash
that peels in 1 to 2 weeks.
Treatment: antibiotics, bed rest, and
symptomatic treatment.
Pelvic Inflammatory Disease (PID)
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Inflammation of fallopian
tubes, ovaries, or both,
along with vascular and
supporting structures
within the pelvis, except
the uterus.
Symptoms include fever,
pelvic pain, foul-smelling
vaginal discharge.
Treatment: antibiotic
therapy, bed rest.
Common diagnostic tests used for female clients with
symptoms of reproductive system disorders.
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Alpha-fetoprotein (AFP): a protein normally
produced by the liver and yolk sac of a fetus.
Cultures: vaginal culture, wet mount, gonorrhea,
Chlamydia.
Human Chorionic Gonadatropin (HCG): is a
hormone produced during pregnancy. Urine and
blood.
Mammary Glands
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15 lobes
Divide into lobules
The alveoli produce
milk
Milk pass from the
alveoli to
Lactiferous ducts to
Lactiferous sinus
where it accumulates.
Mastitis
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Breast infection
Contributing factors –
Alteration in nipple
integrity
Delayed emptying of
breast milk
Clinical findings –
Unilateral breast pain,
warmth and redness
Malaise and flu-like
symptoms
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Also called chronic
cystic mastitis.
Symptoms include
lumps that are single
or multiple cysts,
frequently fluid-filled.
Aspiration or surgical
excision may be
indicated.
TX: Danazol (X)
Vitamin E
No caffeine
Fibrocystic Breast Disease:
Self Breast Exam
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Monthly breast selfexams.
Women by age 20.
More likely to notice
changes -- including
masses or lumps -- that
could be early signs of
cancer.
One week after
menstruation.
Mammography
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A special type of X-ray of the
breasts.
Can show tumors long before
they are big enough to be
noticed.
Are recommended every
year or two for women older
than 40.
Recommended for younger
women who have symptoms
of breast cancer or who have
a high risk of the disease.
Breast Cancer
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Key to cure is early detection by physical
examination, mammography, breast selfexamination.
A painless mass or thickening is the most
common presenting symptom.
Treatment: lumpectomy, mastectomy,
radiation, chemotherapy, medications.
Breast Cancer Stages
Breast Cancer
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Management:
Chemotherapy
Tamoxifen – reduces
risk and recurrence
and death
Surgical Procedure
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Lumpectomy
Partial mastectomy
Simple mastectomy
Modified radical
mastectomy
Simple Mastectomy (Total)
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A surgical procedure to
remove the whole
breast that contains
cancer.
Some of the lymph
nodes under the arm
may also be removed
for biopsy.
Dotted line shows
entire breast is
removed. Some lymph
nodes under the arm
may also be removed.
Modified Radical Mastectomy
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A surgical procedure to
remove the whole breast
that has cancer, many of
the lymph nodes under the
arm, the lining over the
chest muscles, and
sometimes, part of the
chest wall muscles.
Dotted line shows entire
breast and some lymph
nodes are removed.
Part of the chest wall
muscle may also be
removed.
Lumpectomy and Partial Mastectomy
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Partial Mastectomy: A surgical
procedure to remove the part of
the breast that contains cancer
and some normal tissue around
it. This procedure is also called
a segmental mastectomy.
Lumpectomy: A surgical
procedure to remove a tumor
and a small amount of normal
tissue around it.
Breast-conserving surgery.
Dotted lines show area
containing the tumor that is
removed and some of the
lymph nodes that may be
removed.
Sentinel lymph node mapping
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A method of determining
whether cancer has spread
beyond the primary tumor and
into the lymph system.
Blue dye is injected into the
area around the original
cancer site.
The dye moves to the first
lymph node (sentinel node)
that drains close to the cancer
site.
Forms a map pattern of
lymphatic fluid.
The map can show where the
cancer is likely to spread and
which lymph node is most
likely to have cancer cells.
Functions of the male reproductive system
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Hormone production
Deposit Sperm
Spermatogenesis
Major Structures:
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Glans Penis: urination
and deposit semen
Scrotum: encloses the 2
testes and maintains
temperature suitable for
sperm production.
Testes: Produce sperm.
Produce and secrete
testosterone.
Structures of the male reproductive system.
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Epididymis: stores maturing
sperm
Vas Defrens: carries sperm
upward from epididymis to the
ejaculatory duct.
Ejaculatory Duct: During
ejaculation, semen passes through
the ducts and exits the body via the
penis.
Spermatic Cord: Cord-like
structure formed by the vas
deferens and surrounding tissue.
Cowper’s Glands: secrete fluid
that neutralize urine acidity in
urethra prior to passage of semen.
Seminal Vesicles: secrete fluid
high in fructose to nourish sperm.
Prostate Gland: secretes fluid that
initiates sperm movement and
nutrition.
Urethra: passage of urine and
semen
Cryptorchidism
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Absence of one or both
testes from the scrotum.
Failure of the testis to
move, or "descend," during
fetal development from an
abdominal position, through
the inguinal canal, into the
ipsilateral scrotum.
Most testes descend by the
first year of life (the majority
within three months)
Phimosis
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A condition in which the foreskin is tightly stretched around the head of
the penis and cannot be pulled back freely.
Can occur naturally.
Triggered by an infection under the foreskin or chronic conditions.
A very tight foreskin may interfere with urination or sexual function.
Prevented by good hygiene.
Treatment with certain medicated creams.
Circumcision
Circumcision
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Male circumcision is the
removal of some or all
of the foreskin
(prepuce) from the
penis.
Local anesthesia
Injected at the base of
the penis, in the shaft,
or applied as a cream.
The foreskin is pushed
from the head of the
penis and clamped with
a metal or plastic ringlike device.
Structural Male Disorders
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Hydrocele–a benign, nontender collection of
fluid within the space of the testes and the
spermatic cord.
Spermatocele–benign nontender cyst of the
epididymis or the rete testis.
Variocele–dilation of veins of the scrotum.
Torsion of the spermatic cord–twisting of the
vascular pedicle of the testis.
BENIGN PROSTATIC HYPERPLASIA (BPH)
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Enlargement of prostate
gland that occurs with
aging.
Symptoms related to
partial or complete
obstruction of the
urethra.
Treatment includes
medications, balloon
dilation, urethral stent,
thermotherapy, and the
transurethral resection
(TURP).
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Symptoms of BPH
• Urgency of urination
• Frequency of urination
• Abdominal straining
• Nocturia
• Impairment of size and
force of stream
• Intermittent hesitancy
• Incomplete bladder
emptying
• Terminal dribbling
• Dysuria
• Eventual renal failure from
urinary obstruction
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A resectoscope inserted through the urethra, for the treatment of BPH. A
wire loop cuts away prostate tissue and seals blood vessels with an
electric current.
The nurse carefully assesses the patient for
symptoms of TURP syndrome, including:
1.
2.
3.
4.
5.
6.
7.
dramatic increase in BP
full, bounding pulses
bradycardia
tachypnea
confusion
agitation
temporary blindness
1.
2.
Assesses the patency of
inflow and outflow tubing,
rate of irrigation, and
bladder distention by
palpation
The nurse should hang
irrigation solution bags no
higher than two to three
feet above the level of the
patient's bladder. A 0.9%
sodium chloride solution is
used for irrigation.
Prostate Cancer
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Second leading cause of cancer deaths in
men.
Early symptoms include dysuria, weak
urinary stream, increased frequency.
Treatment depends on extent of disease and
age of client; includes surgery, radiation, and
hormone therapy.
Prostate Tests
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Digital rectal exam: (DRE)
is an exam of the rectum.
A rectal exam to examine
the the prostate for lumps
or anything else that seems
unusual.
Prostate Smear:
Smear/Biopsy to examine
tissue for disease.
Prostate-Specific Antigen
(PSA): prostate cancer
screen. High PSA level:
These include urinary tract
infections, benign prostatic
hyperplasia (BPH) and
prostatitis. normal range <4
ng/ml. Annual >50 yrs.
Testicular Cancer
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Unknown cause, several factors seem to increase
risk.
Past medical history of undescended testicle(s),
abnormal testicular development, Klinefelter's
syndrome (a sex chromosome disorder).
Small, hard, painless lump is usually first symptom
noted.
Men should perform a testicular self-examination
(TSE) monthly.
Treatment includes surgery, chemotherapy, and
radiation.
15 – 34 yrs
Diagnostic tests used for male clients with symptoms of
reproductive system disorders.
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Semen Analysis: Male
fertility test. Measures
the amount and quality
of a man's semen and
sperm.
Testicular Self
Examination:
Examination of the
testicles. Monthly
during or after a
shower while standing.
Testicles should feel
firm, but not rock hard.
>15 yrs
Penile Cancer
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Bacteria harbored in foreskin of uncircumcised
male are irritants to glans penis and prepuce,
thought to be carcinogenic.
HPV causative factor
Symptoms: itching/burning on penis, painless,
nodular growth on foreskin, fatigue, weight loss.
The primary treatment is surgery.
TX: Surgical procedure, cryotherapy,radiation
therapy
Prevention: Circumcision, condom use, smoking
cessation.
Inflammatory disorders
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Epididymitis is
inflammation of
epididymis.
Orchitis is
inflammation of
testes.
Prostatitis is
inflammation of
prostate.
Treatment for all
includes antibiotics,
bed rest, scrotal
support, and ice to
the area.
Impotence:
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Inability of adult male to
have erection firm
enough or to maintain it
long enough to
complete sexual
intercourse.
Three types: functional,
atonic, and anatomic.
Treatment: external
devices to promote
erection, surgery,
medications.
Infertility
Etiology and management of infertility.
Inability to produce offspring.
 Basic infertility workup is initiated when
conception has not occurred after 6 to 12
months of unprotected intercourse.
 The goal of treatment is successful
achievement of a pregnancy carried to full
term.
Medication:
 Clomid (clomiphene citrate)
 Pregnyl (human chorionic gonadotropin)
 Pergonal (menotropins)
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Compare the following contraceptive
methods
Natural method
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Prevention of
pregnancy.
Safety, ease of use,
effectiveness, and
cost should be
considered when
choosing a method.
Sterilization is
considered
permanent and
effective.
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Oral contraceptives
Depo-Provera
Lunelle
Mirena
Transdermal patch
Vaginal Ring
Intrauterine device
Barriers
Spermicides
Sterilization
Tubal ligation
Vasectomy
Independently review the
effects of aging on the female
and male reproductive system.
Vasectomy
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Male sterilization by surgical
excision of the vas deferens.
Minor surgical procedure that
can be performed in a
physician's office in less than
half an hour
Another method of birth
control must be used until a
follow-up sperm count test is
done
2 months after the vasectomy
It takes about 10 to 20
ejaculations for sperm count
to be zero.
Contraception