Chapter 23 A Located behind and below fallopian tubes, anchored to uterus and broad ligaments; size and shape of large almonds B At birth, contain several hundred thousand graafian follicles (epithelial sacs in which ova develop) embedded in connective tissue C Between menarche and menopause, one follicle matures each month, ruptures from ovarian surface, is expelled into pelvic cavity, and enters fallopian tube 1. Oogenesis: formation of a mature ovum in graafian follicle 2. Ovulation: expulsion of ovum from follicle into pelvic cavity 3. Release of ovarian hormones: maturing follicle produces estrogens (estradiol, estrone, and estriol); corpus luteum produces progesterone and estrogens a. Estrogens: stimulate development of secondary sexual characteristics (e.g., breasts, pubic hair) and thickening of endometrium; accelerate protein anabolism; stimulate long bone calcification b. Progesterone: prepares endometrium for implantation of fertilized ovum; inhibits uterine contractions during pregnancy; promotes development of alveoli of estrogen-primed breasts in preparation for lactation A Location: in pelvic cavity between bladder and rectum 1. Shape and size: pear-shaped, approximate size of clenched fist a. Corpus (body): upper, main portion; fundus is bulging upper area of corpus; two openings from fallopian tubes, one into cervix b. Cervix: narrow, lower portion; internal os adjacent to uterus; external os adjacent to vagina; isthmus (lower uterine segment) separates corpus from cervix C Location: over bladder in pelvic cavity; cervix joins vagina; ligaments (e.g., broad ligaments, uterosacral ligaments, posterior ligament, anterior ligament, round ligaments) maintain position of uterus A Mons veneris: hairy, skin-covered pad of fat over symphysis pubis B Labia majora: hairy, skin-covered folds C Labia minora: small inner folds covered with modified skin D Clitoris: small mound of erectile tissue, below junction of two labia minora E Urinary meatus: opening into urethra; posterior to clitoris; anterior to vagina F Vaginal orifice: posterior to urinary meatus; opening into vagina; hymen G Skene glands: small mucous glands; ducts on each side of urinary meatus; prone to infection, especially gonococci H Bartholin glands: two small glands; ducts on each side of vaginal orifice; prone to infection, especially gonococci A Location: under skin, over pectoralis major B Size: associated with deposits of adipose tissue, not amount of glandular tissue; glandular tissue approximately same in all females 1. Internal: divided into lobes and lobules; excretory duct leads from each lobe to opening in nipple 2. External: nipples; areola (circular pigmented area surrounding nipples) D Function: secrete milk (lactation) See Chapter 12, Nursing Care of Clients with Urinary/Reproductive system Disorders, Review of Anatomy and Physiology of the Reproductive System, Structures of the Male Reproductive System Period of reproductive organ maturation and preparation for reproductive function A Physical and physiologic changes a. Occurrence: 9 to15 years of age b. First sign: thelarche (breast budding) c. Later: acceleration of body growth; adrenarche (growth of pubic and axillary hair) d. Last: menarche (onset of menses); occurs after peak of growth spurt; ovaries produce estrogen; menstrual cycles may be anovulatory and irregular during first year a. Occurrence: 10 to 14 years of age; less dramatic than females’ b. First sign: testicular growth; scrotal changes c. Ejaculation: starts early in puberty (wet dreams) with few active sperm d. Later: penile growth; pubic, axillary, and facial hair; deepening voice; body growth spurt; spermatogenesis (second year after onset); increased sweat gland activity; periodic erections and emissions of mature sperm A Periodic vaginal bleeding related to changes in uterus and ovaries; cyclical from time of menarche to menopause B Length of cycle: measured from onset of uterine bleeding to onset of next period of bleeding; mean cycle length is 28 days; range of 21 to 45 days C Regulated by hormonal communication between hypothalamus and pituitary gland (hypothalamic-pituitary cycle) and ovaries and uterine endometrium D Ovarian activity: during each cycle several follicles begin maturation process; usually one reaches full maturity, expels its ovum, which enters a fallopian tube 1. First phase (menstrual or ischemic): shedding of spongiosum endometrium with discharge through vagina a. Prostaglandin level in endometrium peaks causing vasoconstriction and myometrial contractions resulting in menstruation b. Low estrogen and progesterone levels stimulate release of follicle-stimulating hormone (FSH) c. FSH combines with low level of luteinizing hormone (LH) stimulating ovarian estrogen production 2. Second phase (follicular [ovary] or proliferative [endometrium]) a. Endometrium regenerates and thickens in preparation for possible implantation b. Simultaneously, single dominant follicle develops from group of maturing follicles and approaches full maturation under influence of estradiol produced by ovarian follicles c. Rising blood levels of estradiol exert negative feedback on FSH production and positive feedback on LH production d. Estradiol’s feedback effects are exerted on hypothalamic production of FSH-releasing hormone and LH-releasing hormone, which control hypophyseal production of FSH and LH e. Resulting surge in LH level causes ovulation f. Ovulation usually occurs 14 days before menstruation; ovum remains viable for 24 to 36 hours 3. Third phase (luteal [ovary] and secretory [endometrium]) a. Begins after ovulation; relatively finite time period of about 12 to 14 days b. Continuing LH production forms temporary endocrine gland (corpus luteum) from ruptured follicle c. Granulosa and thecal cells of follicle enlarge, divide into and occupy cavity of follicle, and produce progesterone and estrogen d. Progesterone stimulates already proliferated endometrium to become glandular with a high glycogen-secreting potential (preparation for implantation) e. Without fertilization corpus luteum becomes nonfunctional 10 to 12 days after ovulation; progesterone and estrogen blood levels drop f. Negative feedback effect of estrogen on FSH ceases; first phase of menstrual cycle begins a. Contraceptive agents prevent pregnancy by inhibiting gonadotropin (FSH and LH) production, affecting both pituitary and hypothalamic centers b. Synthetic preparations of estrogen-like and/or progesterone-like compounds are contained in oral, transdermal, vaginal, and parenteral contraceptive agents and some intrauterine devices 2. Premenstrual syndrome (PMS) a. Discomfort from ovulation to menstruation b. Clinical findings: bloating, breast tenderness, constipation/diarrhea, acne, moodiness, fatigue, insomnia, backache, cramping (1) Dietary modifications (e.g., reduction of salt, refined carbohydrates, alcohol, caffeine) (2) Stress management, exercise, rest (3) Nonsteroidal inflammatory inhibiting agents (antiprostaglandin action) effective in relieving abdominal cramping associated with ischemic or menstrual phase of cycle; diuretics, progesterone, oral contraceptives also effective 3. Premenstrual dysphoric disorder A Perimenopause (climacteric): gradual cessation of ovarian function and menstrual cycles; begins between age 40 and 60, average age 51; lasts 2 to 10 years B Menopause: cessation of menstrual periods for 12 consecutive months C Postmenopause: time after menopause 1. Ovaries: loss of ability to respond to gonadotropic hormones; dramatic decrease in levels of circulating estradiol and progesterone 2. FSH gonadotropin blood level: increased because ovarian production is no longer inhibited; false-positive pregnancy test may occur 1. Atrophic changes in reproductive organs or hormonal stimulation of sympathetic nervous system a. Early manifestations: dyspareunia, weight gain, facial hair growth, cardiac palpitations, hot flashes, profuse diaphoresis, constipation, pruritus, faintness, headache b. Long-range manifestations: osteoporosis, cardiovascular disease c. Emotional/behavioral responses: irritability; anxiety about loss of reproductive function, libido, feelings of womanliness
Nursing Care to Promote Childbearing and Women’s Health
Health Promotion
Female Reproductive System
Ovaries: Female Gonads
Uterus
Vagina
Vulva (External Genitalia)
Breasts (Mammary Glands)
Male Reproductive System
Puberty
Menstrual Cycle
Perimenopause
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