Chapter 14 Michele O’Grady This chapter provides understanding and insight into disordered pathophysiology of male and female reproductive systems. Developing understanding and insight will help you to offer safer, high‐quality and effective informed care. There are a vast number of disorders of the reproductive systems of both boys and girls and it would be difficult to include all of them in a single chapter. However, common presentations have been chosen and an attempt made to select the common conditions that are likely to present throughout your career. Why is dealing with the reproductive system more difficult than any other system in the body? The short answer is that adults are often embarrassed to talk about or even consider that their children are developing into sexual human beings. Alongside this, is the possibility that some reproductive health issues may affect future fertility, which is an emotional subject for parents (Wilson & Koo, 2010; Leser & Francis, 2014). The use of language when dealing with children and young people can be challenging and depends on the conversations that parents may or may not have had with their children (Rogers et al., 2015). What children call their genitalia can be varied and in fact some girls do not have a name for their vagina, so taking a history can be tricky. Throughout the chapter, this issue will be highlighted with helpful tips to overcome language difficulties. However, you, as the practitioner, need to be comfortable discussing matters affecting reproductive health as children and young people will sense your discomfort, which will affect your therapeutic relationships. One of the characteristics of the male reproductive organs is that the majority of the organs are outside the body. The reproductive system is closely linked with the neuroendocrine systems, which produce hormones that are required for development and sexual maturation. The urinary system and the reproductive system are collocated. The testes are located in the scrotum outside the body because sperm production and storage need to be 3 degrees cooler than body temperature. For an in‐depth examination of the anatomy and physiology, please see Peate and Gormley‐Fleming (2015). See Fig. 14.1 for an overview of the male reproductive system (see also Chapter 13). Figure 14.1 The male reproductive system. Source: Peate & Gormley‐Fleming 2015. Reproduced with permission of Wiley. There are a number of common male reproductive issues that boys may experience. The healthcare worker is likely to see many of these during their career. Common problems affecting the male reproductive tract are shown in Table 14.1. Table 14.1 Some common male reproductive conditions It is possible and even highly likely that boys who have a problem with their genitalia may be embarrassed and reluctant to tell their parents or health professionals about their concern. In an ideal world, boys could choose if they want to be examined by a female or male nurse/doctor but often there is no option. Top tips for examination of boys’ genitalia: There are a number of conditions relating to male reproductive health, but this chapter will consider cryptorchidism, and testicular torsion, which is a surgical emergency. Cryptorchidism refers to the absence of one or both testes from the scrotum. It occurs in about 1% of infants over 3 months (Fawzy et al., 2015). The precise cause is still unclear, but it is considered to be a common condition. See Fig. 14.2 for a depiction of the development of the male reproductive tract. Figure 14.2 The development of the male reproductive tract. Source: Peate & Gormley‐Fleming 2015. Reproduced with permission of Wiley. Classification of undescended testes are based on testicular location, which may be either along the normal line of descent (abdomen, inguinal canal, external ring, pre‐scrotal, upper scrotal) or in an ectopic position. True undescended testes: The testes lie along the normal path of descent in the abdomen or inguinal region but do not reach the scrotum. Ectopic testes: The testes lie outside the normal path, for example, the perineum or penile shaft. Ascending testes: The testes have descended but are now lying outside the scrotum. Causes: Not generally understood but there are some risk factors: Surgical intervention is the treatment option. The surgical procedure undertaken brings the testis into the scrotum and anchors it to the wall of the scrotal sac. There are several factors that lead to parents’ distress when treating this condition. Usually it is diagnosed in young babies and surgical intervention in a young baby is very traumatic for parents, carers and the whole family. Minimising distress is as important as treating the problem. Families require adequate explanations, detailed information and constant reassurance. Occasionally, an older child will present with one or both testes undescended. This can be very traumatic for all concerned and the outcome for future fertility may not be positive. For pre‐ and post‐operative care, see Glasper and Richardson (2006). The principal cause of testicular torsion is when the tunica vaginalis fails to encase the testicle and the testis hangs free from the vascular structures leading to a partial or complete venous occlusion. This can lead to ischaemia (tissue death) and could result in a loss of one or both testicles. It is estimated that 1 in 4000 males under 25 years of age will experience testicular torsion, with a peak onset of 13 years (Ta et al., 2016). It can affect babies prenatally and neonates (Fehér & Bajory, 2016). There are a number of predisposing factors relating to testicular torsion. Often it is spontaneous, but it can sometimes follow direct trauma. The physical care required to treat the patient is essential and any delay in providing surgical intervention can have serious repercussions in the post‐operative period. The importance of psychological care associated with an emergency surgical intervention is outlined in the following box. The female reproductive system is more complex than the male reproductive system. Similarities exist between both systems, with the endocrine system producing hormones required for biological development, sexual arousal and puberty. The female reproductive system is predominantly hidden inside the body and the urinary system is collocated but not a part of the sexual organs. The female reproductive system is made up of the ovaries, fallopian tubes, uterus, vagina, and external genitalia (see Figs 14.3 and 14.4). The breasts are also part of the female reproductive system. Figure 14.3 The female reproductive system. Source: Peate & Gormley‐Fleming 2015. Reproduced with permission of Wiley. Figure 14.4 The uterus and associated structures. Source: Peate & Gormley‐Fleming 2015. Reproduced with permission of Wiley. The function of the female reproductive system is to produce ova and allow fertilisation of the ova to take place and the fetus to grow inside it. After birth, the reproductive system also prepares the breasts to feed the infant. As with the male reproductive system, it is expected that the reader has an in‐depth knowledge of the anatomy and physiology of the system including the issues of puberty and menstrual cycle. There are a range of conditions affecting female reproductive health and this chapter will concentrate on some of the most common (see Table 14.2). Table 14.2 Some common female reproductive conditions Menarche, or the first period, has been described in the literature as a major milestone in a girl’s life and many cultures celebrate the transition into womanhood (Pitangui et al., 2013; Pateriya & Kanhere, 2014). It should be a normal part of life but the aforementioned authors suggest that problems in menstruation are responsible for loss of education as girls frequently do not seek medical help with significant health problems relating to abnormalities. Pitangui et al. (2014) describe dysmenorrhoea or pain during menstruation as the most common gynaecological complaint of women. Primary dysmenorrhoea can be described as painful menstruation in women with a normal pelvic anatomy. Secondary dysmenorrhoea refers to pain due to a disorder in the pelvis. The physiology behind dysmenorrhoea is an increased production of the hormone prostaglandins by the endometrium causing uterine contraction and pain. Dysmenorrhoea affects more than 80% of women (Pitangui et al., 2014). Pain begins shortly before menstruation commences and can last 1–3 days. The pain can be associated with cramps, nausea and vomiting, and syncope (fainting). It can be very debilitating for some women and has been associated with missed days in school and a deficit in education (Azurah et al., 2013). The literature also indicates that girls and adult women are unlikely to seek medical help and endure symptoms that may indicate an underlying pathology. Menstruation is a normal part of everyday life for women. However, it would appear that girls do not always discuss problems with their parents, and nurses need to use opportunities to take a menstrual history from girls whenever an overall health history is taken and allow girls and their parents to discuss any issues relating to dysmenorrhoea. Almost all girls will have abdominal pain at one time or another. The pain can be anywhere between the chest and groin. Most of the time, it is not caused by a serious medical problem; however, sometimes abdominal pain may be a sign of something serious.
Disorders of the reproductive systems
Aim
Introduction
The male reproductive system
Male reproductive issues
Cryptorchidism (also known as undescended testes)
Classification
Diagnosis
Treatment
Potential complications
Psychological care
Testicular torsion
Signs and symptoms
Physical examination
Treatment options
Female reproductive health issues
Menstrual problems
Abdominal pain in girls
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