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Reproductive and sexual problems

**Figure 108.1** **Issues of sexual identity**

**Figure 108.2** **Checking the testes**

Structural abnormalities

At birth or in early childhood various anatomical abnormalities are evident within the reproductive, genital or urological organs that result from failures in embryological development: absence of vagina or other parts of the female reproductive tract. Occluded vagina but remainder present and normal in shape; ambivalent or ambiguous genitalia – actual sex determined through chromosomal analysis and endocrine status. In the male micropenis, hypospadias (urethral opening on underside of penis), epispadias (urethral opening on upper part of penis), and cryptorchidism (undescended testis). These are assessed for surgical intervention at an appropriate age in order to protect future function where possible and prevent other problems (e.g. testicular cancer if testes remain undescended) and to protect the child’s body image.

Developmental issues

Reproductive and sexual functioning is a combination of mind and body function. Adolescence is when these processes and functions mature and become a focus of attention. Part of becoming a sexually mature adult may involve difficult decisions about sexual identity. This is not necessarily easier with the modern, open and free views of sexuality as the issue needs to be considered earlier in development. In addition, hormone levels are relatively unstable and interlinked with basic drives centrally controlled within the brain: sleeping, eating, drinking and exercising. The moody, relatively uncooperative and uncommunicative teenager is difficult to establish a rapport with, thus. ‘You have an issue – this is a confidential service and we are here to help’ facilitates a working relationship.

Signs of puberty may not necessarily be welcomed or understood by the child , despite videos and classroom teaching sessions. Puberty can occur precociously as early as 8 years of age or be delayed beyond 16 years.

Male signs of puberty and potential problems

Signs of puberty are facial, underarm and pubic hair, with increases in glandular activity – sweat = odour; sebaceous gland activity – potential acne; pubic hair; voice change and break; growth spurts, which = potential acne; the voice changes or breaks; and growth spurts continue until maturity.

Penile and scrotal developmental problems

Phimosis: the foreskin remains too tight for retraction to allow for cleansing underneath glans – failure to do this can result in penile cancer. Surgical division with conservation of foreskin is now preferred to circumcision. Phimosis may also result from infection where identification and appropriate treatment is required in addition to surgery.
Balanitis: swelling of the glans (± foreskin). The glans is red and sore as a result of irritation (from for example: accumulated smegma, infection – thrush or sexually transmitted – dribbled urine, highly scented shower gels).
Paraphimosis: occurs if a tight foreskin is retracted round the penis causing the glans to swell and resulting in significant pain. Emergency surgical management and treatment of any infection is required. This can occur at any age, without sexual activity and requires urgent referral. A young male who presents with genital pain must be examined.
Varicocoele: swollen veins within pampiniform plexus. Although not a problem in itself, the resultant increases in temperature can cause low sperm counts and male infertility.
Hydrocoele: painless fluid-filled sacs that enlarge the scrotal contents but feel soft and mobile, these may cause anxiety.
Testicular cancer: the most common cancer in young men, but it is easily treated if detected and diagnosed early. Self-examination of testicles is to be promoted in order to achieve this. If boys know how their testes and epididymis feel, they are more likely to feel the harder rougher shape of a potentially cancerous change (Figure 108.2).
Inguinal hernia: occurs where a section of intestine has prolapsed into the scrotum through the inguinal canal. This requires surgical repair.

Trauma

Frenulum breve (‘short’): this may rupture with masturbation or sexual intercourse and can lead to a haematoma under the glans epidermal tissue which will resolve. If pain or trauma continues with sexual activity, further surgical division may be necessary but not circumcision.
Testicular torsion causes acute pain as a result of ischaemia from twisting of the testicle about the spermatic cord.
Testicular trauma causes significant pain.

Female signs of puberty and potential problems

Increase in height and weight, female body shape – breast development, widening hips, hair growth pubic, underarms with increased sweat gland activity – odour, and sebaceous gland activity – potential acne; particularly linked with menstrual cycle post menarche. A girl’s menstrual pattern is one of the major indicators for her general as well as reproductive health.

Tags: Children and Young Peoples Nursing at a Glance

Jun 7, 2018 | Posted by admin in NURSING | Comments Off

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Reproductive and sexual problems