Reproductive System

© USMLE Galaxy LLC

Anatomy + Physiology
● Male reproductive system
○ External organs
■ Scrotum contains the testes
■ Produce sperm and seminal fluid
■ Sperm = male gamete
■ Ejaculated by the penis
● Female reproductive system
○ Internal organs.
■ Ovaries, fallopian tubes, uterus, cervix, vaginal canal
■ Ovum = female gamete
Major functions: Male
1. To produce, maintain, transport, and nourish sperm (the male reproductive
cells), and protective fluid (semen).
2. To discharge sperm within the female reproductive tract.
3. To produce and secrete male sex hormones.

BPH- Benign Prostatic Hyperplasia

● The prostate and surrounding tissue grows excessively
● The prostate goes through two main growth periods as a man ages.
○ The first is early in puberty, when the prostate doubles in size.
○ The second begins around age 25 and continues during most of a man's life. As you age, your
prostate may get larger. BPH is when it gets large enough to cause problems.
● Normal size: walnut → golf ball
● Enlarged gland squeeze urethra
● Thickened bladder wall
● Bladder loses ability to fully empty
● Causes urinary retention
● Can lead to symptoms
BPH Assessment Findings
● Dribbling after urination
● Excessive nocturnal urination
● Frequency
● Sense of incomplete
bladder emptying
● Urine leaking
● Incontinence
● Sexual dysfunction

Diagnosis
● Digital rectal exam. The doctor inserts a finger into the rectum to check your
prostate for enlargement.
● Urine test. Analyzing a sample of your urine can help rule out an infection or other
conditions that can cause similar symptoms.
● Blood test. The results can indicate kidney problems.
● Prostate-specific antigen (PSA) blood test. PSA is a substance produced in your
prostate. PSA levels increase when you have an enlarged prostate. However,
elevated PSA levels can also be due to recent procedures, infection, surgery or
prostate cancer.
BPH Treatments
● Alpha blockers
○ Alfuzosin, doxazosin, tamsulosin
○ Relax bladder neck muscles and muscle fibers in the prostate, making urination easier.
○ Work quickly
● 5-alpha reductase inhibitors.
○ Finasteride, dutasteride
○ Shrink prostate by preventing hormonal changes that cause prostate growth.
○ Can take up to 6 months to work
● Tadalafil (Cialis)
○ Often used to treat erectile dysfunction- relaxes smooth muscles allowing more blood flow
○ Can also treat prostate enlargement

Female Reproductive System

Major functions: Female
○ Uterus
● Hosts the developing fetus
● Produces vaginal and uterine secretions
● Passes the anatomically male sperm through to the fallopian tubes
○ Ovaries
● Produce the anatomically female egg cells.
● Produce and secrete estrogen and progesterone

Fertilization
● Male gamete + female gamete
● Sperm is ejaculated towards the cervix, and if an ovum is currently in the fallopian tube, it can then
be fertilized by sperm
● After fertilization
○ Sperm + ovum → zygote
○ Blastocyst
○ Embryo
○ Fetus
● Once fertilized, the the ovum undergoes changes that prevents additional sperm from entering
● Each reproductive cell has 23 chromosomes
● Sperm carry X or Y chromosomes: XY for Males, XX for Females.
 Implantation
● Once the zygote has been formed, it is moved forward into the uterus and implants 6-8 days after
fertilization.

● Once implanted a ball of cells starts to form; the blastocyst. These layers of cells form our earliest layers
of our body;
○ Endoderm: this gives rise to our GI tract and Respiratory structures
○ Ectoderm: the outermost layer of cells or tissue of an embryo in early development, or the parts
derived from this, which include the epidermis and nerve tissue.
○ Mesoderm: the middle of the three germ layers, gives rise to muscle, connective tissue, cartilage,
bone, notochord, blood, bone marrow, lymphoid tissue, and to the epithelia (surface, or lining,
tissues) of blood vessels, lymphatic vessels, body cavities, kidneys, ureters, gonads (sex organs),
genital ducts, adrenal cortex, and certain other tissues.

● The blastocyst secretes human chorionic gonadotropin (HCG) to ensure the corpus luteum remains viable
and secretes estrogen and progesterone for the first 2-3 months of life.
○ The increase in these hormones are what are believed to cause morning sickness during the first
trimester

Pelvic Shapes
● Gynecoid
○ Normal female pelvis
○ Transversely rounded or blunt

● Anthropoid
○ Oval shaped
○ Adequate outlet, narrow pubic arch

● Android
○ Angulated or heart-shaped
○ Resembles a male pelvis
○ Not favorable for birth or labor
● Platypelloid
○ Flat with coal inlet
○ Wide transverse diameter, short anteroposterior diameter making birth and
labor difficult
Pelvic Shape Examples

Menstrual cycle
Ovarian Hormones
● Released by the anterior pituitary gland
○ FSH (Follicle stimulating hormone”)
○ LH (Luteinizing hormone)

● Produce changes in the ovaries and the endometrium

● Control menstrual cycle; typically each menstrual cycle lasts 28

days.
○ The first day in which a biologically female starts to bleed is
day 1.

Sex hormones
Hormone Gender Source Function
Testosterone Male Testes ● Stimulates male secondary sex characteristics

Estrogen Female Ovaries ● Stimulate female secondary sex characteristics

● Repair the wall of the uterus
● Control ovulation

Progesterone Female Ovaries ● Prevents the wall of the uterus breaking down
Placenta
Contraceptives
● Types:
○ Oral Contraceptives
○ Intrauterine Devices
○ Barrier contraceptives
■ Diaphragm
■ Condoms

Oral Contraceptives
● Oral contraceptives work by stopping the process of ovulation, preventing implantation, and
inhibiting sperm travel.
● Contain estrogen and progesterone doses that inhibit the hypothalamus from producing hormones
needed for ovulation.
● Complications:
○ Clotting risk
■ Increases platelets and clotting factors that increase the woman’s risk for
thrombophlebitis.
■ Contraindicated in clients who already have a high risk of clotting related disease:
● Family history of CVA
● >40 years old and smoke
● History of DVT, PE, MI, CVA, etc.
● When taken consistently, are about 99.7% effective.
○ Take every day, at the same time of day
○ Do not take effect until seven days after they are started.
■ Use another form of contraception during the initial seven days
What if your client forgets their pill?
● For one day:
○ Taking a contraceptive pill right away and continuing with the usual schedule.
● For two days:
○ Take two pills today and another two pills tomorrow.
● For three or more days:
○ Throw out the rest of the pack and start a new pack of pills the following Sunday.
○ Use additional methods of contraception ( barrier methods, condoms) until seven days after
starting a new pack of pills.

NCLEX Question
The nurse is educating the client regarding oral contraceptives. All of the following statements by
the nurse are true, except:

A. “Oral contraceptives are drugs containing combined doses of estrogen and progesterone
that stop ovulation.”
B. “Oral contraceptives increase your risk for thrombophlebitis and hypertension.”
C. “They are almost 99% effective when taken consistently.”
D. “They prevent sperm from entering the cervical os.”
E. “Oral contraceptives require a prescription from a healthcare provider."
Answer: D
Choice D is correct. This nurse’s statement is incorrect, therefore the correct answer to the question. Oral contraceptives work by
stopping the process of ovulation, preventing implantation, and inhibiting sperm travel. Prevention of sperm from entering the
cervical os is the mechanism of action of barrier contraceptive methods (example: Diaphragm).

Choice A is incorrect. This nurse’s statement is correct. Oral contraceptives contain fixed or altered estrogen and progesterone doses
that inhibit the hypothalamus from producing hormones needed for ovulation.

Choice B is incorrect. This nurse’s statement is correct. Oral contraceptives increase platelets and clotting factors that increase the
woman’s risk for thrombophlebitis.

Choice C is incorrect. This nurse’s statement is correct. Oral contraceptives, when taken consistently, are about 99.7% effective.
Generally, the efficacy rate is about 92 to 95%, but the efficacy rate approaches 99.7% if taken perfectly. The nurse needs to
emphasize that oral contraceptive intake should not be based on the timing of sexual intercourse. Meaning, to ensure utmost efficacy,
the client should take them every day at the same time of day, regardless of whether she will have sex.

Choice E is incorrect. This statement is true. Oral contraceptives are prescription medications and cannot be obtained without a
prescription from a healthcare provider. They are not available over-the-counter and should be prescribed and monitored by a
healthcare professional. It is important for the nurse to emphasize the importance of consulting with a healthcare provider to obtain
oral contraceptives and to receive appropriate guidance and monitoring.

Polycystic Ovarian Syndrome

● Ovum begins to develop, but stops before it is fully mature
● Ovum not released, and many then build up in the ovary
● Leading cause of infertility
Assessment Findings
● Dysfunctional bleeding
● Amenorrhea
● Hirsutism
● Acne
● Infertility

Treatment
● Oral contraceptives
● Antiandrogens
● Fertility agents
● **Greater risk of cancer later in life.
Breast Health
Common Breast Conditions

● Painful breasts (mastalgia)

● Fibroadenomas (fibrous lump)
● Inflammation of the breast (mastitis)
● Breast lumps
● Breast cysts
● Nipple discharge
● Nipple and breast itchiness

Breast Checks-Breast Self Exam (BSE)

1. Stand in front of a mirror with hands on hips and shoulders straight. Look at
the shape, color and size of breasts and nipples
2. Then raise arms in the air and look for the same things-the shape, color, size
of breasts and nipples
3. Lay down with arm bend at the elbow resting above the head. Stretch hands
so palms and fingers are flat-this allows the client to feel without poking
their breasts.

The nurse should educate their client to perform this self exam once a month,
typically 3-5 days after their menstrual cycle starts again. Clients should try to do
this exam the same time every month
Client Teaching-when to see a HCP
● New Lumps
● Changes in the shape of the breast
● Changes in the color of the breast
● Changes in the nipple
● Discharge from the nipple
● Puckering or dimpling of breast skin
● Persistent breast pain
● Persistent nipple or breast itching or rash
Diagnosis
Mammogram: breast x-ray can show breast changes that are too small for the
client or their HCP to feel

● Every 1-2 years starting at age 40

● Should continue until at least 75

Cervical health
What does the cervix do?

● Allows menstrual blood to flow from the uterus to the vagina and then exit
the body
● Keeps the cervical gate closed when the client is not fertile
● Creates cervical mucus that changes all cycle long to prevent-or
promote-pregnancy in sync with ovulation
● A healthy cervix will remain tightly closed until a pregnant individual is in
labor
Client education for cervix health
● Encourage clients to keep their annual OB/GYN exams and routine Pap
smears (typically now every 3 years in a woman without cervix issues)
● Follow the health care providers recommendations
● Get the HPV vaccination
● Quit smoking
● Eat well and eliminate stress

Endometriosis
Endometriosis is an often
painful disorder in which
tissue similar to the tissue
that normally lines the
inside of your uterus —
the endometrium — grows
outside your uterus.
Endometriosis most
commonly involves your
ovaries, fallopian tubes and
the tissue lining your pelvis
Assessment Findings
The most common findings are pain and menstrual irregularities

● Pain in the lower abdomen, lower back, pelvis, rectum, or vagina

● Pain that occurs during sexual intercourse or while defecating
● Menstrual: abnormal menstruation, heavy menstruation, irregular
menstruation, painful menstruation, or spotting
● Gastrointestinal: constipation or nausea
● Abdominal: abdominal fullness or cramping
● Also common: infertility

Diagnosis
● Pelvic exam: the HCP manually palpates ares in the pelvis for
abnormalities, such as cysts on the reproductive organs or scars behind
the uterus
● Ultrasound
● Magnetic resonance imaging (MRI)
● Laparoscopy
Treatments:
● Supportive care
● Medications
○ OTC medications: NSAIDs (ibuprofen, naproxen sodium)
○ Hormone therapy
■ Hormonal contraceptives
■ Gonadotropin-releasing hormone agonists and antagonists
■ Aromatase inhibitors-reduce amount of estrogen in the body
■ Progestin therapy
● Pills, IUD, Nexplanon
● Self-care (heating pad)
● Surgery: Electrosurgery and laparoscopic surgery
○ Cauterization, ablation, endometrial ablation, hysterectomy with ovarian removal

Toxic Shock Syndrome

● An accumulation of toxins that are produced by the microorganism, Staphylococcus aureus.
● Clients at risk:
○ Using tampons
○ Cervical caps
○ Diaphragms

Any of these devices can cause the build-up of S. aureus colonies in the areas where they are
located, leading to Toxic Shock Syndrome (TSS).

Education:

● Change regularly
● Keep clean
NCLEX Question
The nurse is talking to a group of women about the dangers and ways of acquiring toxic shock syndrome
(TSS). The nurse would mention that all of the following women have a high risk of acquiring TSS,
except:

A. A teenage girl using an absorbent tampon.

B. A 29-year-old woman using a cervical cap.
C. A 31-year-old woman using a diaphragm.
D. A 35-year-old woman using oral contraceptives.
E. A woman who recently gave birth and is using postpartum vaginal packing.

Answer: D
Choice D is correct. A woman using oral contraceptives is not at risk for toxic shock syndrome
(TSS) since there is no area where the Staphylococcus aureus bacteria can infect/build a colony.

Choices A, B, C and E are incorrect. Toxic shock syndrome is an accumulation of toxins that are
produced by the microorganism, Staphylococcus aureus. Women who are using tampons, cervical
caps, and diaphragms are at risk for TSS due to the build-up of S. aureus colonies in the areas
where they are located. Postpartum vaginal packing is a potential risk factor for developing toxic
shock syndrome (TSS). Vaginal packing is sometimes used after childbirth to control bleeding or
provide support to the perineum. However, if the packing is left in place for an extended period or
if it becomes contaminated, it can create an environment conducive to bacterial growth and
increase the risk of TSS.
STDs
 Gonorrhea
● Cause
○ Neisseria gonorrhoeae
● Most common
○ 15-24 year olds
● Transmission
○ Oral, anal, or vaginal sex
○ Mother to baby during a vaginal delivery
● Testing
○ Urine, genital secretions, or blood test.
● Treatment
○ Antibiotics
■ Single dose: IM
ceftriaxone plus oral azithromycin
■ Co-infection with chlamydia:
doxycycline (long term)

Syphilis
● Cause
○ Treponema pallidum
● Stages
○ 1, 2 and 3
○ Most infectious during 1st and 2nd
stages
● Transmission
○ Direct contact with lesions
○ Mother to baby
● Testing
○ Genital secretions, or blood test.
● Treatment
○ Antibiotics
○ Most common - Penicillin
Chlamydia
● Cause
○ Chlamydia trachomatis
● Most common
○ 2x more frequent in women
● Transmission
○ Oral, anal, or vaginal sex
○ Mother to baby during a vaginal delivery
● Testing
○ Urine or genital secretions.
● Treatment
○ Antibiotics
○ Most common - azithromycin or
doxycycline

Herpes
● Cause
○ HSV-1 → cold sores
○ HSV-2 → genital herpes
● Transmission
○ Oral, anal, or vaginal sex
○ Mother to baby during a
vaginal delivery
● Testing
○ Physical exam - presence of sores. Confirmed with lab tests as needed.
● Treatment
○ Antiviral drugs
TORCH Syndrome
T - Toxoplasmosis Symptoms in the newborn
● Fever
O - Other Agents, ● Difficulties feeding
● Hepatomegaly
R - Rubella ● Splenomegaly
● Jaundice
C - Cytomegalovirus, ● Hearing impairment
● Abnormalities of the eyes
H - Herpes Simplex