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STI Global City College of Nursing

Lecture Notes on Female Reproductive System System

Prepared By: Mark Fredderick R Abejo R.N, MAN


College of Nursing


Female Reproductive System

Lecturer: Mark Fredderick R. Abejo RN, MAN

Anatomy and Physiology of the Female Reproductive System

Medical and Surgical Nursing 1 Abejo

STI Global City College of Nursing
Lecture Notes on Female Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN

Internal Female Reproductive System  W/ hair outside but smooth inside

 fatty skin folds from MONS PUBIS to PERINEUM and
Vagina protects the labia minora , urinary meatus & vagina
 Birth canal
 Muscular tube (8 cm) Labia Minora
 Connects cervix of the uterus to the exterior  Thin, pink, smooth, hairless, extremely sensitive to
 Receives erect stimulus during sexual intercourse pressure, touch and temperature.
 Opens to outside  The glands of labia minora lubricate the vulva.
 It is formed by the frenulum and the prepuce of the
Cervix clitoris which is also very sensitive
 Neck-like part
 Entrance to uterus Clitoris
 Capable of very wide dilation during childbirth  Composed of glans & shaft that is partially covered by
Uterus (womb)  GLANS is small and round and is filled w/ many nerve
 Virtually at a right angle to the vagina endings and rich blood supply
 Specialized to allow the embryo to become implanted in its  SHAFT is a cord connecting the glans to the pubic bone;
inner wall and to nourish the growing fetus from the w/in it is the major blood supply of clitoris
maternal blood
 3 layers: Urethral Meatus
 Peritoneum (outer)  Entrance of urethra, opens approximately 1cm below
 Myometrium (middle) – labour, cramps clitoris
 Endometrium (inner) – sloughed off every 28 days
during menstrual cycle Skenes Gland
 lubricates the external genitalia
Fallopian Tube (oviducts)
 Found at the top of the uterus on each side Bartholins Gland
 Function is to conduct ova (eggs) from the ovary to the  alkaline in ph, helps improve sperm survival
 Not physically attached to the ovaries
 Fimbraie (finger-like projections) help draw the egg
into the fallopian tubes
 Right arm = fallopian tube, right hand = fimbraie,
left fist = ovary
 Fertilization occurs near the ovarian end of the fallopian
tube (must take place within 24 hours of ovulation)
 Movement of the egg down the fallopian tube is through OVARIAN CYSTS
peristalsis  Cysts are nonneoplastic sacs that contain fluid or
 Ampulla: site for fertilization semisolid material.
 Isthmus : site for tubal ligation  Ovarian cysts are usually small and produce no
symptoms, ovarian cysts should be thoroughly
Ovaries (female gonads) investigated as possible sites of malignant change.
 Main female reproduction organs  Common types include:
 Produces egg cells which are nonmotile  Follicular,cysts, which are usually very small,
 Produces steroid hormones (estrogen and progesterone) semitransparent, and fluid-filled
 Held in place by ligaments  Lutein cysts, including corpus luteum cysts, which
 Each ovary contains numerous follicles (“shell”) each are functional, nonneoplastic enlargements of the
containing an egg ovaries
 Follicle serves as the endocrine gland  Theca-lutein cysts, which are commonly bilateral
 All immature eggs are produced before birth and filled with clear, straw-colored fluid
 30th week of gestation – 7 million eggs  Polycystic (or sclerocystic) ovary disease is part of
 At birth – 2 million the Stein-Leventhal syndrome.
 Puberty – 300 000 – 400 000  Ovarian cysts can develop any time between puberty and
 300 to 400 mature eggs released in a life time menopause, including during pregnancy.
 At puberty, 1 mature egg is released every 28 days  Corpus luteum cysts occur infrequently, usually during
 Will occur usually until the age of 45-50 early pregnancy.
 When female has no more eggs to release she goes
into menopause
 (physiological)
 Fertilization must take place to complete meiosis II
 As many as 20 follicles can begin development at
the beginning of the menstrual cycle
 Older eggs have more chances of having problems
with the baby

External Female Reproductive Parts

Mons Pubis
 Soft fatty tissue, lies directly over symphysis pubis &
becomes covered w/ hair just before puberty
 It is where the pubic hair grows.

Cause / Risk Factors

Labia Majora
Medical and Surgical Nursing 2 Abejo
STI Global City College of Nursing
Lecture Notes on Female Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN

 Follicular cysts arise from follicles that over distend  Endometriosis usually becomes progressively severe
instead of going through the atretic stage of the menstrual during the menstrual years, and subsides after
cycle. menopause.
 Corpus luteum cysts are caused by excessive  Infertility is the primary complication.
accumulation of blood during the hemorrhagic phase of  Spontaneous abortion may also occur.
the menstrual cycle.
 Theca-lutein cysts are commonly associated with
hydatidiform mole, choriocarcinoma, or hormone
therapy. Cause / Risk Factors
 Polycystic ovary disease results from endocrine  Trasportation---during menstruation, the fallopian tubes
abnormalities. expel endometrial fragments that implant of the ovaries
or pelvic peritoneum
 Formation in situ--inflammation or a hormonal change
triggers metaplasia (differentiation of coelomic
Clinical Manifestation
epithelium to endometrial epithelium)
 Induction--this is a combination of transportation and
 Usually small cysts produces no symptoms, unless formation in situ and is the most likely cause. The
torsion or rupture causes signs of acute abdomen. endometrium chemically induces undifferentiated
 Low back pain mesenchyma to form endometrial epithelium

 Mild pelvic discomfort

Clinical Manifestation
 Dysmenorrhea (painful menstruation)-- Pain usually
 Dyspareunia ( difficult and or painful intercourse) begins 5 to 7 days before menses reaches its peak and last
for 2 to 3 days. It is less cramping and less concentrated
 Abnormal uterine bleeding in the abdominal midline than primary dysmenorrheal
 Lower abdominal pain and in the vagina --
 Acute abdominal pain (similar to that of appendicitis) -in
ovarian cysts with torsion  Pain to posterior pelvis and back
 Multiple tender nodules on uterosacral ligaments or in the
rectovaginal system. They enlarge and become more
 In corpus luteum cysts appearing early in pregnancy, the tender during menses. Ovarian enlargement may also be
patient may develop unilateral pelvic discomfort and evident.
(with rupture) massive intraperitoneal hemorrhage.  Other symptoms depend on the location of the ectopic
 In polycystic ovary disease, the patient may develop  Ovaries and oviducts--infertility and profuse menses
amenorrhea ( abnormal absence or stoppage of menses),  Ovaries or cul-de-sac--deep-thrust dyspareunia (painful
Oligomenorrhea (abnormally infrequent menstruation), or intercourse)
infertility secondary to the disorder as well as bilaterally  Bladder--suprapubic pain, dysuria (painful or difficulty
enlarged ovaries. urinating), hematuria (Presence of blood in the urine)
 Rectovaginal septum and colon--painful defecation,
Collaborative Management rectal bleeding with menses, pain in the coccyx or sacrum
 Small bowel and appendix--nausea and vomiting, which
worsen before menses, and abdominal cramps
 Follicular cysts usually don't require treatment because
 Cervix, vagina, and perineum--bleeding from endometrial
they tend to disappear spontaneously within 60 days.
deposits in these areas during menses
 If they interfere with daily activities,
Clomiphene citrate P.O. for 5 days or
Diagnostic Test
progesterone I.M. for 5 days, reestablishes the
ovarian hormonal cycle and induces ovulation.  Laparoscopy may confirm the diagnosis and determine
the stage of the disease
 Oral contraceptives may also accelerate involution of
functional cysts (including both types of lutein cysts and  Barium enema rules out malignant or inflammatory
follicular cysts). bowel disease.
 Treatment for corpus luteum cysts that occur during
Collaborative Management
pregnancy is symptomatic because these cysts diminish
during the third trimester and rarely require surgery.  For young women who want to have children includes:
androgens, such as danazol, which produce a temporary
 Theca-lutein cysts disappear spontaneously after
remission in Stages I and II. Oral contraceptives and
elimination of hydatidiform mole or choriocarcinoma, or
progestins also relieve symptoms.
discontinuation of HCG or clomiphene citrate therapy.
 Stage III and IV (when ovarian masses are present), they
 Polycystic ovary disease treatment may include; drugs,
should be removed to rule out cancer.
such as clomiphene citrate to induce ovulation or if drug
therapy fails to induce ovulation, surgical wedge
resection of one-half to one-third of the ovary.  The patient may undergo conservative surgery, but the
 Surgery may become necessary for both diagnosis and treatment of choice for women who don't want to bear
treatment. children or who have extensive disease (StageIII and IV)
is a total abdominal hysterectomy performed with
bilateral salpingo-oophorectomy.
 Endometrial tissue appears outside the lining of the
uterine cavity. UTERINE LEIOMYOMAS ( Myomas / Fibromyomas )
 This ectopic tissue usually remains in the pelvic area,  These neoplasms (tumor; any new and abnormal growth)
most commonly around the ovaries, uterovesical art the most common benign tumors in women.
peritoneum, uterosacral ligaments, and the cul-de-sac, but  They usually occur in the uterine corpus, although they
it can appear anywhere in the body. may appear on the cervix or on the round or broad
 Active endometriosis usually occurs between ages 30 and ligament.
40, more so in women who postpone child-bearing.
Cause / Risk Factors

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STI Global City College of Nursing
Lecture Notes on Female Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN

 Uterine Leiomyomas are usually multiple and usually Clinical features vary with the affected area.
occur in women over age 35  They may include profuse, purulent vaginal discharge
 They affect blacks three times more often than whites.  Low-grade fever
 The cause is unknown, but excessive levels of estrogen  Malaise
and human growth hormone (HGH) probably influence  Lower abdominal pain
tumor formation by stimulating susceptible fibromuscular
 Large doses of estrogen and the later stages of pregnancy
increase both tumor size and HGH levels. Three Types of PID
 When estrogen production decreases, uterine leiomyomas
usually shrink or disappear (usually after menopause) Salpingo-oophoritis (fallopian tubes, and ovaries):
 Acute: sudden onset of lower abdominal and pelvic pain,
Clinical Manifestation usually after menses,
 Pain  increased vaginal discharge
 Submucosal hypermenorrhea (excessive menstrual  fever
bleeding, but occurring at regular intervals and being of  malaise
usual duration)  lower abdominal pressure and tenderness
 Possibly other forms of abnormal endometrial bleeding  tachycardia
 Dysmenorrhea (abnormally painful menses)  pelvic peritonitis
 If tumor is large, the patient may develop a feeling of Chronic: recurring acute episodes
heaviness in the abdomen;
 Increasing pain
 Intestinal obstruction
 Constipation Cervicitis (inflammation of the cervix):
 Urinary frequency or urgency  Acute- purulent, foul-smelling vaginal discharge;
 Irregular uterine enlargement  Vulvovaginitis, with itching or burning
 Red, edematous cervix
Diagnostic Test  Pelvic discomfort
 Blood studies/ anemia will support the diagnosis  Sexual dysfunction
 D&C (dilatation and curettage)  Metrorrhagia; infertility; spontaneous abortion
 Submucosal hysterosalpingoraphy - detects submucosal  Chronic- cervical dystocia, laceration or eversion of the
leiomyomas cervix, ulcerative vesicular lesion (when cervicitis results
 Laparoscopy - visualizes subserous leiomyomas on the from herpes simplex virus type II)
uterine surface

Collaborative Management Endometritis (inflammation of the uterus):

 Acute- mucoopurulent or purulent vaginal discharge
 Treatment of choice for women who desire to have oozing from cervix
children - A surgeon may remove small leiomyomas that  Edematous, hyperemic endometrium, possible leading to
have caused problems in the past or that appear likely to ulceration and necrosis
threaten a future pregnancy  Lower abdominal pain and tenderness
 Tumors that twist or grow large enough to cause  Fever
intestinal obstruction require a hysterectomy, with  Rebound pain
preservation of the ovaries if possible  Abdominal muscle spasm
 Pregnant patient: If a patient uterus no larger than a 6  thrombophlebitis of uterine and pelvic vessels
month normal uterus by the 16th week of pregnancy, the Chronic- recurring acute episodes (more common from
outcome for the pregnancy remains favorable, and multiple sexual partners and sexually transmitted
surgery is usually unnecessary. However if a pregnant infections)
woman has a leiomyomatous uterus the size of a 5 to 6
month normal uterus by the 9th week of pregnancy, Cause / Risk Factors
spontaneous abortion will probably occur, especially with  PID can result from infection with aerobic or anaerobic
a cervical leiomyoma. If surgery is necessary, a organisms.
hysterectomy is usually performed 5 to 6 months after  Any sexually transmitted infection
delivery (when involution is complete), with preservation  More than one sex partner
of the ovaries if possible
 Conditions or procedures, such as cauterization of the
 Appropriate intervention depends on the severity of cervix, that alter or destroy cervical mucus, allowing
symptoms, the size and location of the tumors, and the bacteria to ascend into the uterine cavity
patient's age, parity, pregnancy status, desire to have
 Any procedure that risks transfer of contaminated
children, and general health.
cervical mucus into the endometrial cavity by
 Call your doctor immediately if there is any abnormal instrumentation such as use of a biopsy curet
bleeding or pelvic pain
 Infection during or after pregnancy
 Infectious foci within the body, such as drainage from a
chronically infected fallopian tube
 Recurrent, acute, subacute, or chronic infection of the
oviducts and ovaries, with adjacent tissue involvement.
 PID may refer to inflammation of the cervix, uterus,  Effective management eradicates the infection, relieves
fallopian tubes, and ovaries, which can extend to the symptoms, and avoids damaging the reproductive system.
connective tissue lying between the broad ligaments  Aggressive therapy with multiple antibiotics begins
(parmetritis). immediately after culture specimens are obtained.
 Early diagnosis and treatment prevent damage to the  Infection may become chronic if treated inadequately
reproductive system.  Supplemental treatment of PID may include bed rest,
 Complications of PID may include potentially fatal analgesics, and I.V. therapy
septicemia, pulmonary emboli, shock and infertility.  Narcotics may be needed, NSAID's are preferred for pain
Untreated PID may be fatal. relief.
 Development of a pelvic abscess requires adequate
Clinical Manifestation drainage. A ruptured pelvic abscess is a life-threatening

Medical and Surgical Nursing 4 Abejo

STI Global City College of Nursing
Lecture Notes on Female Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN

condition. If this complication develops, the patient may Treatment:

need a total abdominal hysterectomy, with bilateral
salpingo-oophorectomy Your doctor will determine the course of treatment. Treatment for
most vaginal disorders is aimed at maintaining proper bacterial
balance and treating your irritation and discomfort.

Bacterial vaginitis and trichomonas: Your doctor may prescribe a

VAGINAL PROBLEMS topical cream and or oral medication

Vaginitis Inflammation of the vagina Vaginismus: Your doctor may want to refer you to a doctor who
specialize in psychology, and or one who specialize in sexual
Most common:
Candida vaginitis (yeast infection) topical cream .
Candida vaginitis (yeast infection): Studies shows approximately
75% of all women will have a yeast infection at least once in their
lifetime. Some will suffer form recurring yeast infections. Vaginal
yeast infections may cause pain during urination and or during
sexual intercourse.
effects of this disorder ranges from minimal discomfort to severe,
Symptoms of yeast infection - itching, soreness and may have a disruptive behavioral and somatic changes. Symptoms usually
white, cottage-cheese-like discharge. appear 7 to 14 days before menses and usually subside with its
Bacterial vaginosis: For reasons unknown there may be a change
in the balance of naturally occurring bacteria in the vagina that Cause: Direct cause unknown, PMS may result from a
allows disease causing bacteria to dominate. It occurs commonly progesterone deficiency in the luteal phase ot the menstrual cycle
during reproductive years. or from an increased estrogen-progesterone ratio. Approximately
10% of patients with PMS have elevated prolactin levels
Symptoms - Many women with this infection exhibit no symptoms,
but the predominate sign of this condition is a fishy smelling gray Symptoms:

 Behavioral changes: Mild to severe personality

Trichomonas vaginitis: (produces a refractory vaginal discharge changes
and puritis) - causes itching and irritation of the vulva with
 Nervousness
increased vaginal discharge that may be green and frothy.

 Hostility
Vaginismus: involuntary spastic constriction of the lower vaginal
muscles, usually from fear of vaginal penetration. If severe, this
disorder may prevent intercourse ( a common cause of  Irritability
unconsummated marriages). Vaginismus affects females of all ages
and backgrounds. Patients usually experience muscle spasm with  Agitation
constriction and pain on insertion of any object into the vagina,
such as a vaginal tampon, speculum or diaphragm. *Note -
Vaginismus usually has a psychological origins. It occurs usually  Sleep disturbance
after sexual trauma such as rape or incest. Please seek counseling
and see your doctor.  Fatigue

Vaginal cancer: usually occurs primarily in women over the age of  Lethargy
50, vaginal cancer is very rare, studies shows approximately 2% of
all gynecological cancers. Once cancer appears on the vagina, it
may spread to surrounding tissues, including the bladder, rectum,  Depression
vulva and the pubic bone. Diagnosis is made by your doctor with
thorough examination with a colposcope and biopsy of any  Somatic changes :
suspicious-looking areas.
 Breast tenderness or swelling
Vulvitis: Inflammation of the vulva. May cause itching, burning
and or pain. Pelvic examination and blood test or tests to check for
any STD ( sexually transmitted disease )  Abdominal tenderness or bloating

Symptoms:  Joint pain

Vaginitis: Increased vaginal discharge with an offensive odor,  Headache

burning, itching and pain
 Edema
Vaginal Cancer: Abnormal discharge and bleeding, firm lesion on
any part of the vagina (possible cancer)  Diarrhea or constipation

Vaginismus: muscle constriction, spasm and pain on insertion of  Patient may also experience exacerbations of skin
any object into the vagina problems such as; ache - respiratory problems such
as asthma, and neurologic problems such as
Vulvitis: if your vulva is inflamed and itches seizures.


Medical and Surgical Nursing 5 Abejo

STI Global City College of Nursing
Lecture Notes on Female Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN

 Treated symptomatically: treatment may include; smooth and white. Menopause may also produce excessive vaginal
 Antidepressants, NSAID's (nonsteroidal anti- dryness and dyspareunia due to decreased lubrication from the
inflammatory drugs), vaginal walls, and decreased secretion from Bartholin's glands; a
reduction in the size of the ovaries and oviducts; and progressive
pelvic relaxation as the supporting structures of the reproductive
 Vitamins
tract lose their tone from the absence of estrogen

 Tranquilizers Urinary system: Atrophic cystitis, resulting from the effects of

decreased estrogen levels on bladder mucosa and related structures,
 Sedatives may produce pus in the urine (pyuria), painful or difficulty
urinating (dysuria), and urgency, and incontinence. May have on
occasion have blood in the urine (hematuria)
 Progestins

Breasts: Menopause may cause reduced breast size

 Treatment may require; a diet that is low in simple
sugars, caffeine, and salt, with adequate amounts of
protein, high amounts of complex carbohydrates, Integumentary system: Estrogen deprivation may lead to loss of
and possibly, vitamin supplements formulated for skin elasticity and turgor. The patient may have slight alopecia
PMS (balding), and may experience loss of pubic and axillary hair.

 There is also a self - help groups that exist for Autonomic nervous system: Hot flashes and night sweats. Patient
women with PMS check in your local area. may experience vertigo, syncope, tachycardia, dyspnea, tinnitus,
emotional disturbances such as irritability, nervousness, crying
spells, and fits of anger. Patients may also experience and
exacerbation of preexisting neurotic disorders such as; depression,
MENOPAUSE: The mechanisms of menstruation cease to anxiety, and compulsive, manic, or schizoid behavior
function. Menopause results from a complex, long term syndrome
of physiologic changes, the climacteric-cause by declining ovarian
function. Vascular and musculoskeletal systems: Menopause may also
induce atherosclerosis and osteoporosis.
Artificial menopause, without estrogen replacement, produces
Cause: Physiologic menopause, the normal decline in ovarian symptoms within 2 to 5 years in 96% of women. Since
function caused by aging, begins in most women between ages 40 menstruation in both pathologic and artificial menopause often
and 50 and results in infrequent ovulation, decreased menstruation, ceases abruptly, severe vasomotor and emotional disturbances may
and eventually, cessation of menstruation ( usually ages 45 - 55) result.

Pathologic menopause (premature menopause), the gradual or Menstrual bleeding after 1 year of amenorrhea may indicate
abrupt cessation of menstruation before age 40, cause unknown, organic disease
however certain disorders, especially severe infections and
reproductive tract tumors, may cause pathologic menopause by
seriously impairing ovarian function. Other factors that may incur
pathologic menopause include malnutrition, debilitation, extreme
emotional stress, excessive radiation exposure, and surgical Treatment:
procedures that impair ovarian blood supply.
 Since physiologic menopause is a normal process, it may
Artificial menopause is the cessation of ovarian function following not require intervention.
radiation therapy or surgical procedures.  Atypical or adenomatous hyperplasia requires drug

Symptoms:  Cystic endometrial hyperplasia doesn't require treatment

 Declining ovarian function and decreased estrogen levels  If osteoporosis occurs, calcium is given
accompanying all forms of menopause produce various
menstrual irregularities;
 Decrease in the amount and duration of menstrual flow  Estrogen therapy
Women who take estrogen must be monitored regularly
to detect possible cancer early. If the uterus remains
 Spotting progestin is recommended in addition to estrogen.

 Episodes of amenorrhea (absence or abnormal stoppage FEMALE NFERTILITY: Infertility may be caused by any defect
of menses) and polymenorrhea (abnormal frequent or malfunction of the hypothalamic - pituitary - ovarian axis, such
menstruation) (possible with hypermenorrhea)-excessive as certain neurologic diseases. Other possible cause include:
menstrual cycle
Cervical factors, such as infection and possibly cervical antibodies
 These irregularities may last only a few months or may that immobilize sperm
persist for several years before menstruation ceases
Psychological problems

 Changes in the body's systems usually don't occur until Ovarian factors
after the permanent cessation of menstruation

Tubal and peritoneal factors, such as tubal loss or impairment

Reproductive system: changes may include; shrinkage of vulval secondary to ectopic pregnancy
structures and loss of subcutaneous fat, possible leading to atrophic
vulvitis; atrophy of vaginal mucosa and flattening of vaginal rugae,
possibly causing bleeding after coitus or douching; vaginal itching Uterine abnormalities, such as; congenitally absent, double uterus;
and discharge from bacterial invasion; and loss of capillaries in the leiomyomas or Asherman's syndrome, in which the anterior and
atrophying vaginal wall, causing the pink, rugose lining to become posterior uterine walls adhere because of scar tissue formation
Medical and Surgical Nursing 6 Abejo
STI Global City College of Nursing
Lecture Notes on Female Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN

Approximately 15% of all couples in the US cannot conceive after

regular intercourse for at least 1 year without contraception. 45 to
50% of all infertility is attributed to the female.


Diagnosis requires a complete examination and health history.

Questions includes patient's reproductive and sexual function, past
diseases, mental state, previous surgery, types of contraception used
in the past, and family history


 Intervention aims to correct the underlying abnormality

or dysfunction within the hypothalamic-pituitary-ovarian
 Hormone therapy may be necessary in hyperactivity ;or
hypoactivity of the adrenal or thyroid gland

 Progesterone replacement for progesterone deficiency

 Anovulation requires treatment with clomiphene citrate

 If mucus production decreases (an adverse effect of

clomiphene citrate), small doses of estrogen may be
given concomitantly to improve the quality of cervical

 Surgical restoration may correct certain anatomic causes

of infertility, such as fallopian tube obstruction

 Artificial insemination has proven to be an effective

alternative strategy for dealing with infertility problems

 In vitro (test tube) fertilization has also been successful

Medical and Surgical Nursing 7 Abejo