CHAPTER 21 REPRODUCTIVE SYSTEM Copyright 2007 by Mosby

Structure and Function • Function of the reproductive system is to produce offspring or perpetuate life • A person is able to reproduce after the onset of puberty; Youngest pregnancy: 5 ½ years old, Oldest: 70 years old Early Puberty https: //youtu. be/3 f 8 I 19 v. Rq. WM Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 2

http: //www. innerbody. com/image_repmov/repo 09 -new 4. html#full-description Copyright © 2007 by Mosby, Inc.

Organs of The Male Reproductive Organs • Testicle: Sperm Production • Epididymis: Portion of the vas deferens where the more mature sperm are stored. • Vas Deferens: Long tube that carry the semen from the testicle to the seminal vesicles. • Seminal Vesicles: Where the seminal fluid (nutrient) is formed • Prostate Gland: Contracts for ejaculation and secretes nutrients to protect the DNA • Cowpers Gland: Sectretes lubricant and alkalizes the male urethra as well as the vagina Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 4

Chemical Make-Up of Ejaculate • Sperm (2– 5%) ideal temp 93. 2 200 - to 500 million spermatozoa, per ejaculation, contain the genetic material. • Semen from the seminal vesicles: (65– 75%) produce the main food/energy source for the sperm, contains sugars and amino acids. • Prostate: (25– 30% ) citric acid, proteolytic enzymes, and zinc which serves to help to stabilize the DNA and thins the seminal fluid • Cowpers Gland or pre-ejaculate (1%), responsible for adding lubricant to the urethra and neutralizes the acids present it as well. Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 5

Assessment Techniques of the Male Reproductive System • Palpation: To examine or explore by touching • Most disorders of the reproductive system can be assessed by palpation • Visualization BPH Benign Prostatic Hyperplasia https: //youtu. be/OUOb 5 t. A-bb. M Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 6

Disorders of the Male Reproductive System • Infection: Men are at risk for bacterial, viral and other infections of the prostate and other reproductive glands • BPH or Benign Prostatic Hyperplasia: Hyper growth of the prostate tissue, leading to infection and urinary problems. • Cancer: Can develop in the testicles and prostate • Infertility: Multiple causes • Penile Problems: Inability to obtain an erection, etc. Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 7

Female Reproductive System Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier

Female Organs of Reproduction • Ovaries: • Produce eggs and hormones estrogen and progesterone • Fallopian tubes: • Transport the eggs from the ovary to the uterus • Uterus: • A muscular structure where the egg is implanted after • Cervix: conception • Neck of the uterus; for delivery of a fetus • Vagina: • A muscular tube that extends from the cervix to the exterior of the body Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 9

• • The Uterus Pear shaped Fundus-upper portion Cervix- lower portion Three layers: • Perimetrium – outer layer • Myometrium middle muscular layer • Endometrium – inner layer Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 10

Menstrual Cycle • Lasts approximately 28 days • A complex process of hormone secretion and tissue changes in the uterus • A mature ovum is released from an ovary on about the fourteenth day of each cycle • If the released ovum is not fertilized, the endometrium is released from the body along with the ovum causing menses • The sloughing of this bloody tissue, or menses, lasts from 3 to 7 days • The menstrual cycle continues until 45 to 50 years of age Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 11

Table 21 -1 Menstrual Cycle https: //youtu. be/l. CYq. Ltmo 670 Menstral Cycle https:

Assessment Techniques of the Female Reproductive Tract • Palpation • Most disorders of the reproductive system can be assessed by palpation Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 13

Assessment Techniques of the Female Reproductive Tract • Visualization: PAP Smear • Cells of

Assessment Techniques • Mammography • X-ray technique used to visualize breast tissue • Visualization Example: Cystoscopy • Used to view the bladder & urethra • Assessment for frequent UTI’s, cancer, bladder stones, or for prostate issues in men Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 15

Disorders of the Female Reproductive System • Infertility: Variety of causes • Infection: Bacterial, yeast etc… • STD: Caused by bacteria yeast and viruses • Left untreated can lead to PID, Infertility and Ectopic Pregnancies • Cancer: Cervical, uterine, ovarian and breast Premenstrual syndrome (PMS) • Ovarian cysts: Fluid or semisolid filled sacs that surround the ovaries • Endometriosis: Endometrial tissue grows outside the uterus Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 16

Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 17

Disorders of the Reproductive System • Endometriosis • Presence of endometrial tissue outside the uterus; occurs during child bearing years when estrogen levels are high • Symptoms: pain – sometimes severe- especially during your period. Fertility problems, heavy periods, painful intercourse, pain with bowel movements or urination (especially during period). Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 18

STD’s • Human Papillomavirus - HPV • Most prevalent cause of the development of cervical cancer • Caused by a virus • Two vaccines are available to(Cervarix and Gardasil) protect against cervical cancers in women. Gardasil also protects against genital warts and cancers of the anus, vagina and vulva. Vaccines available for males & females. • Recommended for preteen girls and boys at age 11 or 12 years. Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 19

A defect in the EVER 1 or EVER 2 genes is responsible for this condition , one that has been nicknamed “treeman syndrome” after its unusual symptoms. Epidermodysplasia verruciformis makes victims incredibly susceptible to human papillomavirus, also known as HPV. They can get multiple strands of the virus at once, some of which are exclusive to people suffering from this specific disorder. Over time, warts will begin to form on every inch of the afflicted person's body, particularly the hands and feet. These hardened warts bare an eery resemblance to tree bark and can be severely cumbersome. Many people with this genetic disorder develop skin cancer as a result, which can be fatal. Surgery is often required to remove the warts, and there have been cases where even the most severely afflicted regain some control of their limbs. Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 20

STD’s • Herpes simplex virus • Caused by a virus; causes blister & open sores • One-in-five in the U. S. has some form of herpes • No cure, have Type I (oral) or II (genital) for life • One of the most common sexually transmitted diseases Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 21

STD’s • Syphilis • Caused by a spirochete bacteria • Three stages: • Primary syphilis: Painless sores that appear 7 -21 days after exposure • Secondary: Skin rash and mucous membrane lesions • Tertiary or latent: Goes dormant and attacks the organs, causes dementia, heart failure etc… Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 22

STD’s Continued • Gonorrhea • Highly contagious disease • Caused by bacteria • Can

Infertility & Pregnancy Options • One out of every six couples are infertile • 1/3 of all cases are due to male abnormalities • 1/3 due to female only abnormalities • 1/3 from male and female and unknown causes Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 24

Common Female Reproduction Issues • Ovulation disorders, hinder or prevent the ovaries from releasing eggs. • Uterine or cervical abnormalities, including problems with the opening of the cervix, abnormalities in the shape or cavity of the uterus. • Fallopian tube damage or blockage, which usually results from inflammation of the fallopian tube (salpingitis). Caused by pelvic inflammatory disease, endometriosis or adhesions. • https: //youtu. be/z. CL_2 COlclg Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 25

Common Causes of Male Infertility • Abnormal sperm production or function due to various problems, such as undescended testicles, genetic defects, health problems including diabetes, prior infections such as mumps, and trauma. • Problems with the delivery of sperm such as premature ejaculation, semen entering the bladder during orgasm, certain genetic diseases, blockages or damage to the reproductive organs. • Overexposure to certain chemicals and toxins, such as pesticides, radiation, tobacco smoke, alcohol, marijuana, and steroids (including testosterone). In addition, frequent exposure to heat, such as in saunas or hot tubs, can elevate the testicular temperature, impairing Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 26 sperm production.

Birth Control • Abstinence: 100% effective • Barrier methods: Male & female • Male condoms are 82– 98% • Female condoms are 79– 95% • diaphragm is 84– 94% effective Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 27

The Pill • Oral contraceptives • • Contain estrogen & progestin Prescribed by a doctor Taken at the same time each day Risks: DVT if 35 years and smoke, have a history of blood clots or breast cancer • 91– 99% effective at preventing pregnancy if taken daily. • Injection • Progestin injections in the buttocks / arm every three months • 94– 99% effective • Patch • Worn on the lower abdomen, buttocks, or upper body (not on the breasts) • Releases hormones progestin and estrogen into the bloodstream • Put on a new patch once a week for three weeks. No patch week 4 for a normal period • 91– 99% effective Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 28

• IUD Contraceptives • Small device shaped in a “T” inserted inside the uterus It can stay in your uterus for up to 10 years. More than 99% effective. • Nuva. Ring • A small, flexible vaginal ring used to prevent pregnancy. You put it in for 3 weeks, take it out, then put a new one in a week later. It's just as effective as the pill when used as directed, and you don't have to think about taking it every day. Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 29

Pregnancy and Conception • Ovum (egg) becomes a zygote after fertilization • After fertilized egg implants into the endometrium it’s called an embryo for 8 weeks • From the 8 th week to the 38 -40 th week it is called a fetus Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 30

Pregnancy Terms • Gestation (Synonym for Pregnancy) means to bear… • Gravida /Para are terms used to describe a woman's birth history • Gravida – denotes number of times a woman has been pregnant • Para – denotes how many live births occurred after 20 weeks of pregnancey • Abortus – denotes the number of pregnancies that were lost before 20 weeks whether miscarried or induced. Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 31

Common Pregnancy Testing • • • Blood Test Urine Test Rh-factor Testing Ultrasound Amneocentesis

Rh Factor Testing When a mother is Rhnegative, her body may respond as if it were allergic to the baby & may develop antibodies to an Rh-positive baby. An injection or Rh immunoglobin (Rh. Ig), a blood product that can prevent sensitization of an Rhnegative mother Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 33

Amniocentesis A needle is inserted through the abdominal wall into the uterus, sample of amniotic fluid is removed to analyze for: • Chromosomal abnormalities • Infection • Sex of the baby • https: //youtu. be/XXIW 8 GHw. J_M Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 34

Birthing Process • Three stages of labor • Stage I: muscle contractions of the uterus cause the amniotic sac to rupture and the cervix to open (dilate) to about 10 cm in diameter allowing passage of the fetus • Second stage: delivery of the baby • Third stage: delivery of the afterbirth, or placenta, which takes place about 15 http: //www. youtube. com/watch? v=Xath 6 k. Of 0 NE&feature=related minutes later Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 35

Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 36

epidural Birthing Video: 3 -D Animation https: //youtu. be/z. Io. CKN 9 Bt-I http//www. babycenter. com/2_in side-pregnancy-labor-andbirth_3658872. bc Conception to birth https: //youtu. be/f. Kyljuk. BE 70 Copyright © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 37