Sociocultural differences and their

implications for maternal and child

health nursing
CHANGING CULTURAL CONCEPTS
Assimilation or Acculturation

Refers to this trade of ethnic traditions for those of the dominant
culture. The process of assimilation means that cultural expression is
lost by taking on the customs of the dominant culture.

Ethnocentrism

The belief that ones own culture is superior to all others.
CULTURAL
DESTRUCTIVENESS
CULTURAL
BLINDNESS
CULTURAL
AWARENESS
CULTURAL
SENSITIVITY
CULTURAL
COMPETENCE
Making everyone
fit the same
cultural pattern,
and exclusion of
those who dont
fit,-forced
assimilation.
Emphasis on
differences and
using differences
as barriers
Do not see
or believe
there are
cultural
differences
among
people.
Everyone is
the same.
Being aware
that we all
live and
function
within a
culture of
our own and
that identity
is shaped by
it.
Understandi
ng and
accepting
different
cultural
values,
attitudes,
and
behaviors.
The capacity to
work, effectively
and with people,
integrating
elements of
their culture-
vocabulary,
values,
attitudes, rules
and norms.
Translation of
knowledge in
action.
Reproductive and
Sexual Health
Physiologic readiness for childbearing begins during intrauterine life.
Full function is initiated at puberty when hypothalamus synthesizes
and release gonadotropin-releasing factor stimulator (GnRf) which in
turn triggers the anterior pituitary to begin to release follicle-
stimulating hormone (FSH) and luteinizing hormone (LH).
FSH and LH initiate the production of androgen and estrogen which
in turn initiate visible signs of maturity or secondary sex
characteristics.
Intrauterine Development
Moment of conception
Gonad; is a body organ that produce sex cells. ( ovary for females and testis for
males )
2 undifferentiate ducts;
Mesonephric (wolffian)
Paramesonephric (mullerian)
-- are present by week 7-8
-- under the influence of testosterone, mesonephric duct begins to develop into
male reproductive organs and paramesonephric duct regresses.
-- week 10, paramesonephric duct develops into female reproductive organs.
-- Oocytes, cell that will develop into eggs throughout the womans mature years.
-- week 12, external genitals become visible.



Pubertal Development
Puberty is the stage of life at which is secondary sex changes
begin. Girls are beginning dramatic development and
maturation of reproductive organs at earlier ages than ever
before (9-12 years; for boys, 12-14 years).
Role of Androgen
Hormones responsible for muscular development, physical growth, and the
increase in sebaceous gland secretions that causes typical acne in both boys
and girls.
In males, androgenic hormones are produced by the adrenal cortex and
testes; in females, by the adrenal cortex and ovaries.
ADRENACHE- this development of pubic and axillary hair due to androgen
stimulation.

Role of Estrogen
Increases the development of the uterus, fallopian tubes, and vagina.
Typical female fat distribution and hair patterns.
Breast development.
THELARCHE- the beginning of breast development
Secondary Sex Characteristics
GIRLS:
Growth spurt
Increase in the transverse
diameter o the pelvis
Breast development
Growth of pubic hair
Onset of menstruation
Growth of axillary hair
Vaginal secretions
BOYS:
Increase weight
Growth of testes
Growth of face, axillary,
and pubic hair
Voice changes
Penile growth
Increase in height
Spermatogenesis
ANATOMY AND
PHYSIOLOGY OF THE
REPRODUCTIVE SYSTEM
Gynecology- the study of female reproductive organ.
Andrology- the study of the male reproductive organ
MALE REPRODUCTIVE SYSTEM
Penis
Composed of 3 cylindrical masses of erectile tissue; two termed the corpus
cavernosa and a third, termed corpus spongiosum, contained in the shaft.

Scrotum
The scrotum is a rugated, skin covered muscular pouch suspended from the
perineum. It contains testes, epididymis, and the lower portion of the
spermatic cord. It functions is to support the tertes and help regulate the
temperature of the sperm through contraction or relaxation and moving testes
closer to or further away from the perineum.

Testes
The testes are two ovoid glands to 2-3 cm wide that lie in the scrotum. Each
testes is encased by a protective white fibrous capsule and is composed of a
number of lobules, each lobules containing interstitial cells (Leydigs cells) and
a semiferous tubule. Semiferous tubules produce spermatozoa. Leydigs cell
are responsible for a production f the male hormone testosterone.
MALE EXTERNAL STRUCTURES
MALE INTERNAL STRUCTURES
Epididymis
Responsible for conducting sperm from the testis to the vas deferens, the next
step in the passage to the outside.
Sperm are immobile and incapable of fertilization as they pass or stored at the
epididymis level. It takes 12-20 days for them to travel the length of the
epididymis and a total of 64 days forthem to reach maturity.
ASPERMIA- absence of sperm
OLIGOSPERMIA- fewer than 20 million soerm per milliliter

Vas deferens
The vas deferens is an addition hollow tube surrounded by arteris and veins and
protected by a trick fibrous coating.
VASECTOMY- is a popular means of male birth control

Seminal Vesicles
The seminal vesicles are two convoluted pouches that lie along the lower portion of the posterior
surface of the bladder and empty into the urethra by way of the ejaculatory.

Ejaculatory Ducts
The two ejaculatory ducts pass through the prostate gland and join the seminal vesicles with the
urethra.

Prostate Gland
The prostate is a chestnut-sized gland that lies just below the bladder. The urethra passes through
the center of it, like the hole in a doughnut.

Bulbourethral Gland
2 Bulbourethral or Cowpers land lie beside the prostate gland and by short ducts empty into the
urethra.

Urethra
The hollow tube leading from the base of the bladder, which after passing through the prostate
gland, continues to the outside through the shaft and glans of the penis. It is approximately 8 in (18
to 20 cm) long.

FEMALE REPRODUCTIVE SYSTEM
FEMALE EXTERNAL STRUCTURES
Mons Veneris
Adipose tissue located over the symphysis pubis, the pubic bone joint.

Labia Minora
Two hairless folds connective tissue.
Before menarche, these folds are fairly small; by child bearing age, they are
firm and full; after menopause, they atrophy and again become much smaller.

Labia Majora
Two folds of adipose tissue covered by loose connective tissue and
epithelium.
Serves as a protection for the external genitalia.
Clitoris
Small (approximately 1-3 cm) rounded organ of erectile tissue at the
forward junction of the labia minora.
Sensitive to touch and temperature and is the center arousal and orgasm in
the female.

Hymen
Tough but elastic semicircle of tissue that covers the opening to the vagina
in childhood.
FEMALE INTERNAL STRUCTURES
Ovaries
They are grayish-white and appear pitted, or with minute indentations on the
surface.
Located close to and on both sides of the uterus in the lower abdomen. It is difficuly
to locate them by abdominal palpation because they are located so low.
Functions of the two ovaries is to produce, mature, and discharge ova (the egg cells).
If the ovaries are removed before puberty, the resulting absence of estrogen will
prevent breast from maturing at puberty. Reduction in sixe because of lack of
estrogen.

Ovaries are formed with three principal divisions
1. A protective layer of surface epithelium
2. The cortex, filled with the ovarian and graafian follicles. Here the immature
follicles mature into ova and produce large amounts of estrogen and progesterone.
3. The central medulla, containing the nerves, blood vessels, lymphatic tissue, and
some smooth muscle tissue.
Fallopian tubes
10 cm long
The fallopian tubes arise from each upper corner of the uterine body and extend
outward and backward until each opens at the distal end next to an ovary.
INTERSTIAL- extremely narrow. This segment is approximately 2 cm in length. This
portion of the tube that is cut or sealed in a tubal ligation, or tubal sterilization
procedure.
AMPULLA- longest portion of the tube. It is in thin ampullar portion that
fertilization of an ovum usually occurs.
INFUNDIBULAR- the most distal segment of the tube.

UTERUS
The uterus is a hollow, muscular, pear-shaped organ located in the lower pelvis,
posterior to the bladder and anterior to the rectum.
approximately 5-7cm long, 5 cm wide and in its widest upper part 2.5 cm deep. In
a nonpregant state, it weighs approximately 60 g.
FUNDUS- can be palpated abdominally to determine the amount of uterine
growth occurring during pregnancy, to measure the force of the uterine
contractions during labor.
ISTHMUS- short segment between the body and the cervix. In a nonpregnant
uterus, it is only 1-2 mm in length.

LAYERS OF THE UTERUS
ENDOMETRIUM- the inner one of mucous membrane.
MYOMETRIUM- a middle one of mucous fibers.
PERIMETRIUM- an outer one of connective tissue.
BREAST
The mammary glands, or breast, arise from ectodermic tissue early in utero. They
remain, however, in a halted stage of development until in a rise from in estrogen at
puberty produces a marked increase in size from increased connective tissue and
deposition of fat in girls and a transient increase in boys. Increase in male breast
size in termed GYNECOMASTIA.
women should be taught to always include this region in breast self
Examination or some breast tissue will be missed.
Milk glands of breasts are divided by connective tissue partitions into
approximately 20 lobes.
AREOLA- appears rough on the surface owing to many
sebaceous glands called Montgomerys tubercles.
PELVIS

Serves both to support and protect the reproductive and other pelvic organs.
Its bony ring formed by four united bones: two innominate (flaring hip) bones
that form the anterior and lateral portion of the ring, and the coccyx and
sacrum, which form the posterior aspect.
Each innominate bone is divided into three parts; illium, ischium, and pubis.
ILLIUM- forms the upper and lateral portion.
ISCHIUM- the inferior portion.
SYMPHYSIS PUBIS- the junction of the innominate bones at the front of the
pelvis.
SACRUM- forms the uper posterior portion of the pelvic ring. This is a landmark
to identify when securing pelvic measurements.
COCCYX- composed of five very small bones fused together. This is important
movement because it permits the coccyx to be pressed backward, allowing
more room for the fetal head as it asses through the bony pelvic ring at birth.

MENSTRUATION
A menstrual cycle can be defined as episodic uterine bleeding in
response to cyclic hormonal changes.
MENARCHE- the first menstrual period in girls, may occurs as
early as age 8-9 years old or as late as age 17 and still be within
normal limits.
the normal average length is 28 days (from the beginning of one
menstrual flow to the beginning of the next) However, it is not
unusual for cycles to be as short as 23 days or as long as 35 days.
Physiology of Menstruation
Hypothalamus
The release of Luteinizing hormone-releasing hormone by the hypothalamus
initiates the menstrual cycle; the presence of estrogen represses the hormone.

Pituitary Gland
The anterior lobe of the pituitary gland produces two hormones that act on the
ovaries to further influence the menstrual cycle:
1. FSH, the hormone that is active early in the cycle and is responsible for maturation of
the ovum.
2. LH, hormone that becomes most active at the midpoint of the cucle and is responsible
for ovulation or release of the mature egg cell from the ovary, and growth of the
uterine lining during the second half of the menstrual cycle.
OVARY
Under the influence of FSH and LH, called gonadotropic hormones because they
cause growth in the gonads, ovum matures in one or the other ovary and is
discharged from it each month.

UTERUS
FIRST PHASE OF MENSTRUAL CYCLE (PROLIFERATIVE)
occuring the first 4 or 5 days o a cycle.
SECOND PHASE OF MENSTRUAL CYCLE (SECRETORY)
After ovulation, the formation of progesterone in the corpus luteum
causes the glands of the uterine endometrium to become corkscrew or
twisted in appearance and dilated with quantities of glycogen and mucin,
an elementary sugar and protein. The capillaries of the endometrium in
amount until the lining takes on the appearance of rich, spongy velvet.
This second phase of the menstrual cycle is termed the progestational,
luteal, premenstrual, or secretory phase.
THRID PHASE OF MENSTRUAL CYCLE (ISCHEMIC)
If fertilization does not occur, the corpus luteum in the ovary begins to
regress after 8-10 days. As it regresses, the production of progesterone and
estrogen decreases. With the withdrawal of progesterone stimulation, the
endometrium of the uterus begins to degenerate. The capillaries rupture
with minute hemorrhages, and the endometrium sloughs off.
MENSES: FINAL PHASE OF A MENSTRUAL CYCLE
The products of discharged form the uterus as the menstrual flow or
menses:
Blood from the ruptured capillaries
Mucin form the glands
Fragments of endometrial tissues
The microscopic, atrophied, and unfertilized ovum
Menses is actually the end of an arbitrarily defined menstrual cycle.
Because it is the only external marker of the cycle, however, the first day of
menstrual flow us used to mark the beginning day of a new menstrual cycle.
CERVIX
The mucus of the uterine cervix as well as the uterine body lining changes each
month during the menstrual cycle, when hormone secretion from the ovary is
low, cervical mucus is think and scant. Sperm survival is this type of mucus is
poor. At the time of ovulation, when the estrogen level is high, cervical mucus
becomes thin and copius. Sperm penetration and survival at the time of
ovulation is this thin mucus are excellent. As progesterone becomes the major
influencing hormone during this second half of the cycle, cervical mucus again
becomes think and sperm survival is again poor.
CHARACTERISTIC DESCRIPTION
Beginning (menarche) Average age of onset, 12-13 years;
average range of age, 9-17 years.
Interval between cycles Average 28 days; cycles of 23 to 25 days
not usual
Duration of menstrual flow Average flow, 2-7 days; ranges of 1-9
days not normal
Amount of menstrual flow Difficult to estimate; average 30-80 mL
per menstrual period; saturating pad or
tampon in less than an hour is heavy
bleeding
Color of menstrual flow Dark red; a combination of blood,
mucus and endothelial cells
Odor Similar to that of marigolds
CHARACTERISTIC OF NORMAL MENSTRUAL CYCLE
EDUCATION REGARDING
MENSTRUATION
Menorrhagia- abnormally heavy menstrual flows
Metorrhagia- bleeding between mestrual periods
Menopause- is the cessation of menstrual cycle. The
post-menopausal period is the time of life following
menopause. (between 40-55 years)
AREA OF
CONCERN
TEACHING POINTS
EXERCISE Its good to continue moderate exercise during menses because it
increases abdominal tone. Sustained excessive exercise, such as
professional athletes maintain, can cause amenorrhe.
SEXUAL
RELATIONS
Not contraindicated during menses. Heightened or decreased
sexual arousal may be noticed during menses. Orgasm may
increase menstrual flow.
ACTIVITIES
FOR DAILY LIFE
Nothing is contraindicated.
PAIN RELIEF Any mild analgesic is helpful. Prostaglandin inhibitors such as
Ibuprofen are specific for menstrual pain. Applying local heat may
also be helpful.
REST More rest may be helpful if dysmenorrhea interferes with sleep at
night.
NUTRITION Many women need iron supplementation to replace iron lost in
menses. Eating pickles or cold food does not cause dysmenorrhea.
TYPES OF SEXUAL ORIENTATION

Heterosexuality
is one who finds sexual fulfillment with a member of the opposite
gender.
Homosexuality
is a person who finds sexual fulfillment with a member of his or her
own sex.
Bisexuality
People are bisexual if they achieve sexual satisfaction from both
homosexual and heterosexual relationships.
Transsexuality
an individual who, although of one biologic gender, feels as if he or
she should be of the opposite gender.
DISORDERS OF SEXUAL FUNCTIONS

PRIMARY SEXUAL DYSFUNCTION
1. Erectile dysfunction
Formerly referred to as impotence, is the inability to produce or
maintain an erection long enough for vaginal penetration or partner
satisfation. The majority of reasond why this occurs are physical, such
as aging and atherosclerosis.
2. Premature ejacualtion
Is ejaculation before penile-vaginal contact. Masturbating to orgasm
(in which orgasm is achieved quickly owing to lack of time) may play
a role.
Masculinity and fear of impregnating the woman.
3. Vaginismus
is involuntary contraction of the muscles at the outlet if the vagina when
coitus is attempted. Muscle contraction prohibits penile penetration.
4. Dysparenuia
Pain during coitus. It can occur due to endometriosis (abnormal
placement of endometrial tissue), vaginal secretion, or hormonal
changes such as those that occur with menopause.
SECONDARY SEXUAL DYSFUNCTION
Chronic disease, such as peptic ulcers, or chronic pulmonary
disorders that cause frequent pain or discomfort.
Obese men and women may have difficulty achieving deep
penetration.