CARE OF THE

MOTHER, CHILD
AND FAMILY

COURSE DESCRIPTION/
OBJECTIVE/OUTLINE
Course Description: Principles and techniques of caring for the normal
mothers, infants, children and family and the application of principles
and concepts on family and family health nursing process.
Course Objective: At the end of the course, given actual or simulated
situations/conditions involving the client (normal pregnant woman,
mother, and/or newborn baby, children and the family), the student will
be able to:
1. Utilize the nursing process in the holistic care of client for the promotion
and maintenance of health.

1.1 Assess with the client his/her health condition and risk factors affecting health
1.2 Identify wellness /at risk nursing diagnosis
1.3 Plan with client appropriate interventions for health promotion and
maintenance of health
1.4 Implement with client appropriate interventions for health promotion and
health maintenance taking into consideration relevant principles and techniques
1.5 Evaluate with client the progress of ones health condition and outcomes of care.

I. The
. Family and Family Health
II. The Family Health Nursing Process
III. Methods of Data Gathering
IV. Typology of Nursing Problems in Family Nursing Practice
1. 1st level assessment: identify health threats, foreseeable crisis, health
deficits & wellness potential/state
2. 2nd level assessment: determining familys ability to perform the family
health tasks on each health threat, health deficit, foreseeable crisis or
wellness potential
V. Statement of a Family Health Nursing Problem- health problem and
cause/ contributing factors or health condition and factors related with
non-performance of family health tasks
VI. Developing the Care Plan
VII. Categories of nursing interventions in family nursing practice include:
VIII. Categories of health care strategies and intervention
IX. Evaluation
X. Records in Family Health Nursing Practice
XI. Mother and Child Health
1.Procreative Health
a. Definition and theories related to procreation
b. Process of human reproduction
c. Risk factors that will lead to genetic disorders
d. Common tests for determination of genetic abnormalities
e. Utilization of the nursing process in the prevention of genetic alteration
and in the care of clients seeking services before & during conception

XII. Antepartum/ Pregnancy

1. Anatomy & physiology of the male and female reproductive system
2. Physiology of menstrual cycle
3. The process of conception
4. Fetal circulation
5. Milestones of fetal development
6. Estimating the EDC
7. Common teratogens and their effects
8. Health history: past, present, potential, biographical data, menstrual history,
current pregnancy
(EDD, AOG, gravid, para), previous pregnancies & outcomes (TPAL score),
gynecologic history, medical history, nutritional status
9. Normal changes during pregnancy
a. Local & systematic physical changes including vital signs, review of systems
b. Emotional changes including angers in pregnancy
c. Leopolds maneuver
10. Danger signs of pregnancy
11. Normal diagnostic/laboratory findings & deviations Pregnancy test
12. Appropriate nursing diagnoses
13. Addressing the needs and discomforts of pregnant mothers
14. Prenatal exercises
15. Preparation for labor and delivery

XIII. Intrapartum (Process of Labor & Delivery)

1. Factors affecting labor & delivery process- passenger, passage, power
(primary and secondary) and placenta
2. Functional relationships of presenting part
3. Theories of labor onset
4. Common signs of labor
5. Stages of labor & delivery
6. Common discomforts of the woman during labor and delivery
7. Danger signs during labor & delivery
8. Appropriate Nursing Diagnoses
9. Care of clients experiencing labor & delivery process
10. Physical & psychological preparation of the client:
11. Monitoring of progress of labor delivery
12. Provision of personal hygiene, safety & comfort measures e.g. perineal
care, management of labor pain, bladder and bowel elimination
13. Coping mechanisms of womans partner and family of the stresses of
pregnancy, labor and delivery & puerperium
14. Preparation of the labor & delivery room
15. Preparation of health personnel

XIV. Post Partum

1. Definition
2. Specific Body Changes on the Mother
3. Psychological Changes on the Mother
4. Phases of Puerperium

Taking In
Taking Hold
Letting Go
5. Monitoring of Vital signs, uterine involution, amount & pattern of lochia, emotional responses, responses to
drug therapy, episiotomy healing
6. Possible complications during post partum : bleeding & infection
7. Appropriate Nursing Diagnoses
8. Nursing care of mothers during post partum
a. Safety measures: limitations in movement, protection from falls, provision of adequate clothing, wound
care e.g. episiotomy
b. Comfort measures: exercises, initiation of lactation, relief of discomforts like breast engorgement and
nipple sores, hygienic measures, maintaining adequate nutrition
c. Measures to prevent complication: ensuring adequate uterine contraction to prevent bleeding, adequate
monitoring, early ambulation, prompt referral for complications
d. Support for the psychosocial adjustment of the mother
e. Health teaching needs of mother, newborn, family
f. Accurate documentation and reporting as needed
9. Health beliefs & practices of different cultures in pregnancy, labor delivery, puerperium
10. Current trends in maternal and child care
11. Family planning
XV. The Newborn
The Infant and Family
The Toddler & the Family
The Preschooler and the Family
The Schooler and the Family

The Adolescent & the Family

Adulthood

THE CONCEPT AND DEFINITION OF

FAMILY
The family is a very important social institution
It is generally accepted that the family is the first and oldest social
institution in society. The family is consist of parents and children
who interact with one another. Through this socialization process,
parents are able to hand down socially accepted cultural practice
that serves as initial training for the young to become future
responsible citizen in the future.
Refers to a group of people united by ties of marriage, blood or
adoption. As a group, the members of the family live together
under one roof and that they constitute a single housekeeping unit.
It is a universal institution that has the following common
characteristics:

Associate with one another in their respective roles as husbands and wife, mother
and father, son and daughter or brother ans sisters
As the members of the family enjoy life together playing their different roles, they
tend to create a common culture.

There have been significant changes in the way people

regard the family as a social institution. Friedman
(1992) defines it as Two or more persons who are
joined together by bonds of sharing and
emotional closeness and who identify themselves
as being part of the family
Key Points! A clients family includes any person that
he/she identifies as a family member.
FIVE UNIVERSAL CHARACTERISTICS OF
FAMILY

A family is a social system

A family perform certain basic function
A family has structure
A family has its own cultural values and rules
A family moves through stages in its life cycle

Key Points! The basic function and task of a family focus on

providing physical health, providing for mental health,
socializing its members, reproducing, and providing for
economic well being.

Functions of the FAMILY

Provision of Physical needs: food, shelter, clothing, safety and
healthcare
Allocation of Resources: careful planning and use of family
money, material good, space and abilities
Division of Labor: assigning the workload, including
responsibility for household income and household
management
Socialization: guiding towards acceptable standards of
elimination, food intake, sexual drive, respect for others and
their possession and sense of spirituality
Reproduction, recruitment and release: bearing or adopting
children, adding new members by marriage, and allowing
members to leave
Maintenance of Order: interaction and communication
oppurtinities, discipline, affection, sexual expression
Assistance with fitting into the larger society: community,
schools, spiritual center and organization
Maintenance of motivation and morale: recognition, affection,
encouragement, family loyalty, help in meeting crisis,
philosophy of life, spirituality

FAMILY STRUCTURES
Different structures emanates due to changing family
patterns and cultural; variations practiced by family
members in a given society.
Classifications of Family Based on Internal
Organization:
o CONJUGAL FAMILY
o NUCLEAR FAMILY
o EXTENDED FAMILY
Classification of Family Based on Family
Descent:
o PATRILINEAL FAMILY
o MATRILINEAL FAMILY
o BILATERAL FAMILY

FAMILY STRUCTURES
Classification of Family Based on
Authority
o PATRIARCHAL FAMILY
o MATRIARCHAL FAMILY
o EGALITARIAN FAMILY
o MATRICENTIC FAMILY
Classification of Family Based on
Residence
o PATRILOCAL Residence
o MATRILOCAL Residence
o BILOCAL Residence
o NEOLOCAL Residence
o AVUNCULOCAL Residence

FAMILY STRUCTURES
Alternative Families
o

Cohabitation refers to the unmarried individuals in a

committed partnership living together with or without
children. People may live in cohabitation arrangement,
before in between or as an alternative to marriage.
Gay or Lesbian Family intimate partners of the same
sex may live together or own property together .
Communal Family several people together. They
often strive to be self-sufficient and minimize contact
with the outside society. Members share financial
resources, work and child care responsibilities.
Foster Family children live in temporary arrangement
with paid caregivers. These children are meant to
return to their family of origin when condition permits
or to otherwise be placed for adoption.

CHARACTERISTICS OF A HEALTHY
FAMILY
Healthy

families
foundation
Healthy families
top priority
Healthy families
Healthy families
listen
Healthy families
others
Healthy families

maintain a spiritual
make the family the
ask and give respect
communicates and
values service to
expect and offer

STAGES OF FAMILY DEVELOPMENT

Stage One: Single young adults leave home
Here the emotional change is from the reliance on the family to acceptance of
emotional and financial responsibility for ourselves. Second-order changes include
differentiation of self in relation to family of origin. This means we neither blindly
accept what our parents believe or want us to do, nor do we automatically respond
negatively to their requests. Our beliefs and behaviors are now part of our own
identity, though we will change and refine what we believe throughout our lives.
Also, during this period we develop intimate peer relationships on a deeper level
than we had previously and become financially independent.
Stage Two: The new couple joins their families through marriage or living
together
The major emotional transition during this phase is through commitment to the
new system. Second-order change involves the formation of a marital system and
realignment of relationships with extended families and friends that includes our
spouses.

STAGES OF FAMILY DEVELOPMENT

Stage Three: Families with young children
Emotionally we must now accept new members into the system. This isn't hard
initially because babies come to us in sweet innocent packages that open our
hearts. Unfortunately, in the middle of the night we may wonder what we've
gotten ourselves into. Nevertheless, we adjust the marital system to make space
for our children, juggling childrearing, financial and household tasks. Secondorder change also occurs with the realignment of relationships with extended
family as it opens to include the parenting and grand parenting roles.
Stage Four: Families with adolescents
Emotional transitions are hard here for the whole family because we need to
increase the flexibility of families boundaries to include children's independence
and grandparents' frailties. As noted above, second-order change is required in
order for the shifting of the parent-child relationship to permit adolescents to
move in and out of the system. Now there is a new focus on midlife marital and
career issues and the beginning shift toward joint caring for the older generation
when both children and aging parents demand our attention, creating what is
now called the sandwich generation.

Stage Five: Launching children and moving on

This is one of the transitions that can be most emotionally difficult for
parents as they now need to accept a multitude of exits from and entries
into the family system. If the choices of the children leaving the nest are
compatible with the values and expectations of the parents, the transition
can be relatively easy and enjoyable, especially if the parents successfully
navigate their second-order changes, such as renegotiation of the marital
system as a couple rather than as simply parents.
Stage Six: Families in later life
WhenEriksondiscusses this stage, he focuses on how we as individuals
either review our lives with acceptance and a sense of accomplishment or
with bitterness and regret. Second-order changes require us to maintain
our own interests and functioning as a couple in face of physiological
decline. We shift our focus onto the middle generation (the children who are
still in stage five) and support them as they launch their own children. In
this process the younger generation needs to make room for the wisdom
and experience of the elderly, supporting the older generation without over
functioning for them. Other second-order change includes dealing with the
loss of our spouse, siblings, and others peers and the preparation for our
own death and the end of our generation.

OVERVIEW OF MALE AND FEMALE

REPRODUCTIVE SYSTEM

REPRODUCTIVE DEVELOPMENT

The chromosomal sex or biologic sex

is formed at fertilization. Females
have XX chromosomes and the male
XY chromosomes.
During early fetal life, primitive germ
cells are formed in the 6th and 10th
week in the yolk sac. The Gonads is a
body organ that produces sex cells. At
5th weeks primitive Gonadal tissue is
already formed.

REPRODUCTIVE DEVELOPMENT

At 8th to 10th week, the human embryo

has neutral gonads with two pairs of
duct system. The MULLERIAN Ducts
(Paramesonephric) and the WOLLFIAN
Ducts (Mesonephric) joined at the lower
end.

If the germ cell are XX the gonads

become the Ovaries

If the germ cell is XY the gonads become

the testes

REPRODUCTIVE DEVELOPMENT

The internal genitalia forms at around

13th week from the mullerian (female)
and the wollfian (male) ducts.
If the embryo is XY, the gonads secrets
the following hormones:
o

Mullerian duct inhibitor

which cause mullerian duct
to self destruct and disappear
a process called as
APOPTOSIS.
Testosterone produced by the
Leydig cells which causes
Wollfian duct to develop into
sperm transport system
epididymis, vas deferenses,
and seminal vesicle.

REPRODUCTIVE DEVELOPMENT

The conversion of
testosterone to DHT
dehydrotestosterone causes
development of the prostate
gland. DHT is also
responsible for the
development of the male
external genitalia.

If the embryo is XX, no hormones are

released. Mullerian ducts develop into
oviducts, uterus, and upper vagina. The
Wollfian ducts disappear without
stimulation from testosterone .

REPRODUCTIVE DEVELOPMENT
Female

Male

Clitoral
Gland

Penile Gland

Female
and Male
Reproductive
Homologues
Clitoral
Shaft
Penal Shaft

Labia Majora

Scrotum

Ovaries

Testes

Skenes
Gland

Prostate

Bartholins
Gland

Cowpers
Gland

FEMALE AND MALE

REPRODUCTIVE HOMOLOGUES

PUBERTY
Is the stage of life at which secondary sex changes
begins. Both boys and girls begin dramatic
development and maturation of reproductive organs
at approximately 12 to 13 years.
The hypothalamus apparently serves as gonadostat
or is set to turn on gonad functioning. It is believed
though that the hypothalamus is turned on to release
initial trigger hormones when a girl has developed
enough body fat or has reached the critical weight
that is believed to be around 95 lbs or 43 kgs.
Under the stimulation hypothalamus the pituitary
glands release GONADOTROPIN hormones.
The first sign of pubescence in females is usually
breast bud formation. Puberty ends with menarche
which occurs approximately two years after thelarche

Puberty Changes in Females

Puberty Changes in Males

Breast bud formation

Pubic and axillary hair process

Growth spurts

Increase in body fats as distributed in the breast,

mons pubis, hips and thighs

Vagina lengthens and become rugated

Labia majora and minora becomes thickened and

rugated

Testicular enlargement
Development of penis and scrotum to
adult size and shape is achieved
between 12 to 17
Deepening of the voice due to
hormonal influence to the vocal cords

Onset of spermatogenesis

Growth spurts

FEMALE EXTERNAL GENITALIA

FEMALE EXTERNAL GENITALIA

Vulva or Pudenda

Mons Pubis or Mons Veneris

Labia Majora

Labia Minora

Clitoris
Vestibule

Bartholins Glands

Skeness Glands
Vaginal Orifice

Hymen

Urethral Meatus

FEMALE EXTERNAL GENITALIA

Vulva or Pudenda refers

to the entire female
genitalia.
Mons Pubis is a fold of
fats above the symphysis
pubis that is an
important obstetrical
landmark and protects
the symphysis pubis
from trauma.

It is richly supplied with

sebaceous glands
Escutcheon curly hair

FEMALE EXTERNAL GENITALIA

o

Labia Majora are thick folds

of adipose tissues originating
from the mons and
terminating in the perineum.
o

Its functions is to provide covering

and protection to the external
organs located under it

Labia Minora are two thin

folds of connective tissues
that joins anteriorly to form
the prepuce and posteriorly to
form the fourchette
o

It is moist highly vascular,

sensitive and richly supplied with
sebaceous glands

FEMALE EXTERNAL GENITALIA

o
o

is highly sensitive and

erectile tissue under the
prepuce

Clitoris

seat of a womans sexual arousal

and orgasm
It is surrounded by many
sebaceous glands that produce a
cheese like secretion called
smegma

triangular space between

the labia minora and where the
urethral meatus, Bartholin's
glands and Skenes gland are
located

Vestibule

Bartholins Gland

pair of glands that

are also known as
vulvovaginal gland or
paravaginal gland

FEMALE EXTERNAL GENITALIA

are a pair of gland also

known as paraurethral and
minor vestibular gland

Skenes Gland

or introitus is the
external opening of the vagina
located just below the urethral
meatus.

Vaginal Orifice

The Grafenburg or the G Spot is a

very sensitive area located at the
inner anterior surface of the vagina.

the external opening

of the female urethra is located
just below the clitoris
Urethral Meatus

 Hymen

is a thin circular membrane made of elastic

tissue situated at the vaginal opening that separates the
internal organs from the external organs.

Urethral

Meatus the external opening of the urethra is

located just below the clitoris.

THE NERVE AND BLOOD SUPPLY

The anterior portions
nerve supply is
derived from L1 and
the posterior portion
is derived from S3
Blood supply to the
vulva is provided by
the pudenda artery
and the inferior
rectus artery

THE FEMALE INTERNAL ORGANS

Vagina is a hollow
membranous and
muscular canal about
8 to 12 cm located in
front of the rectum and
behind the bladder
The external opening
of the vagina is
encircled by the
BULBOCAVENOUS
muscle that acts as the
voluntary sphincter.

THE FEMALE INTERNAL ORGANS

Rugae are transverse
folds of skin in the
vaginal wall
Vaginal PH before
puberty is 6.8 to 7.2.
After puberty vaginal PH
becomes acidic going
down to a PH of 4-5.
Doderlein Bacilli a
bacteria that is normally
present in the vaginal
mucus into lactic acid.

THE UTERUS
The uterus is a hollow
muscular, pear shaped
organ located in the
lower pelvis, posterior
to the bladder and
anterior to the rectum.
With
maturity
the
uterus
is
approximately 5 to
7cm long, 5 cm wide
and in its widest upper
part is 2.5cm deep.

THE UTERUS

FUNCTIONS OF THE
UTERUS
It is the cardinal
organ of reproduction
Organ of
menstruation
Uterine contraction
expel the fetus
during labor and to
seal torn blood
vessels after delivery
of the placenta.

THE UTERUS

PARTS OF THE UTERUS

The CORPUS is the
uppermost part and forms
the bulk of the uterus.
Makes up the 2/3 of the
organ. This houses the
growing fetus.
The ISTHMUS is the
short segment between
the isthmus and the cervix
CERVIX considered as the
neck of the uterus. The
cervix is composed of
elastic collage nous tissue
and only 10% muscle
fibers.

THE UTERUS

Layers of the UTERUS

PERIMETRIUM the
outermost serosal layer
attached to the broad
ligament
MYOMETRIUM the
middle muscular layer
responsible for uterine
contraction during labor
ENDOMETRIUM the
innermost ciliated
mucosal layer containing
numerous uterine
glands.

THE UTERUS
1.
2.
3.
4.
5.
6.

UTERINE LIGAMENTS
CARDINAL LIGAMENTS
(2)
BROAD LIGAMENTS (2)
ROUND LIGAMENTS (2)
UTEROSACRAL (2)
ANTERIOR
POASTERIOR

THE UTERUS
The large descending
AORTA divides to
form two iliac
arteries, main division
of the iliac arteries or
hypo gastric arteries.
Ovarian Artery is a
direct branch of the
aorta.

THE FALLOPIAN TUBE (OVIDUCTS)

The oviducts are a pair of tube-like structure

originating from the cornua of the uterus.

Each tube is about four inches long and inch in

diameter.

THE FALLOPIAN TUBE (OVIDUCTS)

FUNCTIONS OF THE
OVIDUCTS
Transport ovum from the
ovary to the uterus
The site of fertilization
Provides nourishment to
the ovum during its
journey

THE FALLOPIAN TUBE (OVIDUCTS)

PARTS OF THE
FOLLOPIAN TUBE

INTERSTITIAL/INTAMURA
L thick walled located inside
the uterus
ISTHMUS the narrowest
portion of the FT.
AMPULLA the middle portion
and the widest part.
INFUNDIBULUM the most
distal portion. It has fingerlike
projection called FIMBRA.

OVARIES

OVARIES
The ovaries are almond
shape glandular organs
located on either side of
the uterus.
Before puberty the ovaries
are smooth, flat ovoid
organs.
Each ovary weighs
between 6 to 9 grams, 1.5
to 3 cm wide and 2 to 5
cm long.

OVARIES
FUNCTIONS OF THE OVARIES

OOGENESIS
OVULATION
HORMONE PRODUCTION

THE MAMMARY GLANDS

THE MAMMARY GLANDS

THE MAMMARY GLANDS

EXTERNAL STRUCTURES
NIPPLE OR MAMMARY
PAPILAE

AREOLA
MONTGOMERY
TUBERCLES

INTERNAL STRUCTURE
LOBES
LOBULES
ACINI CELLS
LACTIFEROUS DUCTS
LACTIFEROUS SINUS

THE MAMMARY GLANDS

HORMONES THAT
INFLUENCE THE
MAMMARY GLANDS

ESTROGEN
PROGESTERONE
HPL
OXYTOCIN
PROLACTIN

THE PELVIS

THE PELVIS
For a baby to be delivered vaginally,
he/she must be able to pass through
the ring of pelvic bone. The pelvic
serves to both support and protect
the reproductive and the other
pelvic organs
The pelvis is divided into three parts:

ILIUM forms the upper lateral

portion.
ISCHIUM forms the lower portion

PUBIS anterior portion of the bone.

The Symphysis Pubis is the junction

of the innominate bone at the front
of the pelvis

THE PELVIS
For
obstetrical
purposes, the pelvis
is further divided
into
the
FALSE
Pelvis
(superior
half) and the TRUE
Pelvis
(inferior
half).
The
LINEA
TERMINALIS
divides the true and
the false pelvis.

MALE REPRODUCTIVE SYSTEM

MALE REPRODUCTIVE SYSTEM

Male External Organ
Penis the male organ of
copulation and urination
Composed of
longitudinal erectile
tissue: Corposa
Cavernosa and
Corposa Spongiosum

MALE REPRODUCTIVE SYSTEM

Male External Organ
PARTS OF PENIS:
Shaft or body
Glans Penis
Prepuce or foreskin
Urethral Meatus

MALE REPRODUCTIVE SYSTEM

Male External Organ
SCROTUM sac like
structure that
contains the testes
that hangs behind
the penis. The
scrotum has no
subcutaneous fat
because the testes
must be kept cool.

MALE REPRODUCTIVE SYSTEM

are oval shaped

glandular organ lying
within the abdominal
cavity early fetal life
and descend in the
scrotum after 28 weeks
gestation.
FUNCTIONS:
Hormone Production
Spermatogenesis
TESTES

PARTS:

Seminiferous Tubules
Leydig Cells
Sertoli Cells

EPIDIDYMIS is a long coiled

tube approximately 20 feet
long and at which the sperms
travels for 12 to 20 days after
it leaves the testis.
VAS DEFERENS it forms the
passageway of the sperm
cells. The contractile power of
the VD propels the sperm to
the urethra during
ejaculation
SEMINAL VESICLE these are
two pouch-like organs
consisting of many saclike
structure located next to the
VD and lying post to bladder
and ant to the rectum

EJACULATORY DUCT the

two ED pass through the
urethra and connect the
urethra carrying the
secretion of the SV.
PROSTATE GLAND is a
walnut shape body lying inf
to the bladder surrounding
the urethra and the ED. It
secretes a thin milky
alkaline fluid that enhance
the sperm survival.
COWPERS GLAND these are
small glands that are
located inf to the PG and
secretes an alkaline fluid

SEMEN
Seminal Fluid or semen
is a mixture of
secretions from SV, PG,
CG,ED and the sperm.
Emission is the
discharge of semen
from urethra
Ejaculation is the
forceful expulsion of
semen
It is alkaline in nature
and is high in basic
sugar and protein,

Stages of Male and Female Sexual Response

Phase 1 is the EXCITEMENT

Phase II is the PLATEAU

Phase III is the ORGASM

Phase IV is the Resolution

EXCITEMENT

In response to sexual stimuli (whether psychological in the form of sexual

thoughts or fantasies, or physical in the form of physical stimulation) the process
of vasocongestion occurs, where more blood flows into the penis than is flowing
out, and the result will usually be that a man will get an erection. How long this
takes, and what the erection feels like will differ from man to man, and for the
same man over time.
Physical changes may include:
-There are also changes in the scrotum and testes, with the testes increasing in
size and the scrotum elevating, coming closer to the body.
-The skin may become flushed; men may experience heightened sensitivity in
parts of their body, like the nipples.
-Some increase in heart rate, blood pressure, and muscle tension

PLATEAU

With continued sexual stimulation this phase represents the

time between the initial arousal and excitement, up until
orgasm. For many men the plateau phase is very short, but this
is the phase that men can extend as a way of controlling
premature ejaculation.
Physical changes during this phase may include:
-An increase in the size of the head of the penis, and the head
may also change color, becoming purplish.
-The Cowper's gland secretes fluid, often referred to as pre-cum,
which comes out of the tip of the penis.
-The testes move further in towards the body, and increase in
size.
-There may be a sex flush, muscle tension, increase in heart rate
and rising blood pressure.

ORGASM
In the first stage:-Contractions in the vas deferens,
seminal vesicles, and the prostate causes seminal fluid
("come" or ejaculate) to collect in a pool at the base of
the penis, in the urethra. This collection is usually felt
as a "tickling" type sensation.
In the second stage of the orgasmic phase:
-Contractions of muscles occur in a "throbbing"
manner around the urethra, and propel ejaculate
through the urethra and out of the body.
-These contractions (which occur at different speeds,
and in different amounts) are usually what are
experienced as highly pleasurable feelings of release.

RESOLUTION

Resolution phase refers to the period of time

immediately following an orgasm, when the body
begins to return to its "normal" state. This phase
includes:
-The loss of the erection as the blood flows out of the
penis, which happens in two stages over the period of
a few minutes.
-The scrotum and testes return to normal size.
-A general feeling of relaxation.

MENSTRUAL CYCLE
Menstrual Cycle can be defined as periodic uterine bleeding in response to cyclic
hormonal changes.
Menarche is the term applied to the first menstruation period of girls.
Menopause is the cessation of menstrual cycle .
Postmenopausal is the time of life following menopause.
Premenopausal is the time when menopausal changes are occuring.

Characteristics of Normal Menstrual Cycle

Beginning

Ave. Range 12 or 13, 9 to 17

Interval

Ave 28 days, cycle of 20 to 45 day is not

unusual

Duration

Ave. flow; 3-7 days; Range 1-9 days

Amount of flow

Difficult to estimate: average of 25 to 50 ml

per menstrual period

Color of menstrual
flow

Dark red: a combination of blood, mucus

and endometrial cells

Odor of menstrual

Odor of marigold

BODY STRUCTURES AND HORMONES

OF THE MENSTRUAL CYCLE
Hypothalamus is the ultimate initiator of
the menstrual cycle. (GNRH)
2. The Pituitary Gland in response from the
hypothalamus and low serum estrogen and
progesterone level APG release the GH
(FSH and LH)
3. The Ovaries during the first half of the
cycle it produces estrogen and
progesterone during the second half of the
cycle.
4. The Uterus changes that occur in the
uterine endometrial are due to the
influence of the ovarian hormone estrogen
1.

ESTROGEN AND PROGESTERONE

Estrogen

Hormone of Women

Breast growth

Development of the female

reproductive organ
Pattern of hair growth
Stimulate the proliferation of the
endometrium resulting in
endometrial thickening
Causes mucus to be thin,
transparent and highly stretchable
Stimulates the growth of the ductile
structure of the breast

Estradiol, Estrone, Estriol

Progesterone

Thermogenic Effect

Relaxes uterine muscle

Promotes growth of the acini cells of

the breast
Causing weight gain by promoting
fluid retention
Causes tingling sensation and feeling
of fullness in the breast before
menstruation
Pregnanediol

Estrogen

inhibit production of FSH

( maturation of ovum)
hypertrophy of myometrium
Spinnbarkheit & Ferning
( billings method/ cervical)
development ductile structure
of breast
increase osteoblast activities of
long bones
increase in height in female
causes early closure of
epiphysis of long bones
causes sodium retention
increase sexual desire

Progesterone

inhibit prod of LH
(hormone for
ovulation)
inhibit motility of GIT
mammary gland
development
increase
permeability of
kidney to lactose &
dextrose causing (+)
sugar
causes mood swings
in moms
increase BBT

 Mittelschmerz
SIGNS OF OVULATION
refers to the

lower
abdominal pain felt at the side of the ovary
that released the ovum.

Spinnbarkheit

is characterized by
cervical mucus that is thin, watery or
transparent abundant and highly
stretchable. When viewed under the
microscope the mucus will reveal a fern
pattern.
Increased basal body temperature
Peak blood level of LH occurs 24 to 48
hours before ovulation

The

primary purpose of menstrual cycle is to prepare the uterus

for pregnancy. In healthy women, menstrual cycle continues
from puberty to menopause, interrupted only by pregnancy and
lactation.
During

each reproductive cycle low level of ovarian hormone

stimulates the Hypothalamus to release GnRH to stimulate the
APG to release FSH that is active early in the cycle and is
responsible in the maturation of the ovum and LH that is most
active during the midpoint of the cycle and is responsible for
ovulation.

Each

female reproductive cycle has two components: the

OVARIAN cycle and the UTERINE cycle. Ovulation takes place
during the 14th day of the 28th day cycle. The 14 days prior to
Ovulation is known as Follicular phase, while the 14 days
following ovulation is the Luteal Phase. The Ovarian cycle is
regulated by changing levels of LH and FSH.
Ovulation

takes place on the 14 day of the 28 day cycle of the

uterine cycle. The 14th day prior to ovulation is subdivided into
two; the Menstrual Phase (days 1-5) and the Proliferative phase
(6 to 14). The 14 days after ovulation constitute the Secretory
Phase. The uterine cycle is controlled by the ovarian hormone
Estrogen and Progesterone.

The

Follicular Phase is the time before ovulation. It is called follicular

phase because the main event at this phase is the formation of the
Graafian follicle from Primordial follicles. During the follicular phase
FSH stimulate the development of around 30 follicles in each ovary. But
among these many developing follicles only one will be selected to
reach full maturity and will release the ovum. FSH also stimulates the
Graafian follicle to secrete estrogen that is responsible for many body
changes during this period.

Around

24-46 hours before ovulation, as serum estrogen levels peaks,

there also occurs a surge in production of LH by the APG which causes
the follicle to reach full maturity and rupture thereby releasing the ovum
within it an event known as Ovulation.
The

Luteal Phase after ovulation the empty follicles is transformed into a

yellowish body called Corpus Luteum that produces large amount of
progesterone and some estrogen under the stimulation of LH.
Progesterone causes secretory changes in the endometrium in
preparation for implantation and other bodily changes different from ones
cause by estrogen.

The

Corpus Luteum has a lifespan of 7 days only. Eight days after ovulation
the corpus Luteum begins to regress resulting in declining serum progesterone
level.

The Menstrual Phase begins on the first day of menses and extends
approximately over first 5 days of the 28 day cycle. Menstruation is
caused by the corpus Luteum regression and the consequent
withdrawal of the progesterone and estrogen. About 2/3 of the
endometrium is shed off every menstrual period. Uterine discharge
includes mucus and epithelial cells in addition to blood. The
average blood los during menstruation ranges from 30 to 80ml. In
womans lifetime she loss 10 to 20 liters of blood due to
menstruations. The average loss of iron during menstruation is
between 12 to 29 mg.

nd become vascular. Leveling off of endometrium occurs at ovulation. Aside from this changes estrogen also stimulates

During the Proliferative Phase estrogen promotes the

growth of new cells and capillaries in the endometrium.
As a result the endometrium thickens by as much as 8 th
folds and become vascular. Leveling off of endometrium
occurs at ovulation. Aside from this changes estrogen also
stimulates the cervical glands to produce abundant
amount of mucus that is thin watery, stretchable and
transparent. Serum estrogen is lowest on the 3 rd day and
highest a day before ovulation.

Progesterone causes the blood vessels in the endometrium

to dilate and assumes a spiral or corkscrew shape. The
corpus Luteum has an average lifespan of about 7 to 8 days.
If fertilization does not takes place the CL shrivels.
Degeneration of the CL results in progesterone withdrawal
which effect leads to the formation and released
prostaglandin and possibly endothelin-1. These substance
causes vasospasm of the spiral arteries and contraction of
myometrium.

nd become vascular. Leveling off of endometrium occurs at ovulation. Aside from this changes estrogen also stimulates

Spasm cuts off blood supply to the uterus causing tissues

ischemia, necrosis and rupture of blood vessels that
eventually leads to endothelial sloughing of the upper two
layers of the endometrium.
Near the end of the secretory phase, just before the start of
menstrual flow, regeneration begins from the retained
basal layer. Rebuilding the endometrium from the basal
layer going upward is responsible for its healing and
rejuvenation without scar formation.

SIGNS AND SYMPTOMS OF MENOPAUSE

The signs and symptoms of menopause are evident in the
parts of the body most affected by the decline in the
hormones estrogen and progesterone.
I.
Urogenital Tract.
.
Bladder: dysuria, incontinence, urinary frequency and
increased incidence of cystitis
.
Uterus: atrophy of uterus
.
Vagina: decrease mucus production causing dryness and
dyspareunia
II. Circulatory System
.
Hot Flashes
.
Increased Cholesterol increased the risk of CVD
III. Mood irritability, loss of sexual desire, depression anxiety
IV. Musculoskeletal: Osteoporosis

V. Other signs and Symptoms:

Sleep disturbance characterized by unusual dreams
and early morning awakenings
Allergies
Appearance of facial hair
Weight gain
Dizziness
Loss of breast mass and firmness

SEXUALITY AND SEXUAL IDENTITY

Sexuality multidimensional phenomenon that include
feelings, attitudes and actions. It has both biological and
cultural components. It encompasses and gives direction to
a persons physical, emotional, social and intellectual
response throughout life
Sex is the term used to denote chromosomal sexual

development
Gender

Identity

is the inner sense a person has of

being male or female. Sense of femininity or masculinity. 2-4
yrs/3 yrs gender identity develops.
Role

Identity

differentiate roles

attitudes, behaviors and attributes that