Human Sexuality And Reproductive Cycle

Question 1

Eccrine glands:

Apocrine glands:

Sebaceous glands:

Answer 1

Eccrine glands and apocrine glands increase secretions and become fully functional during puberty.

Eccrine glands are found over most of the body –

Apocrine glands in the axillae, anal and genital areas. Apocrine sweat is released in response to emotional stimuli.

Sebaceous glands become active under the influence of androgens in both sexes. Secreting sebum most active on face, neck, shoulders, upper back, chest and genitals.

Question 2

What is gender typing?

Answer 2

children acquire the values, motives, and behaviors viewed as appropriate for males and females within a culture.

Question 3

Describe the phases of male sexual response

Answer 3

Excitement phase- rapid erection, thickening of scrotal skin, elevation of the scrotal sac response of vasocongestion. Increased HR, increased BP, flushed skin, increased genitalia blood flow

Plateau phase- increased length and diameter of penis, testes size increases by 50%. Cowper’s gland produces lubrication at the urethral meatus. Orgasm is the climax of the plateau phase.

Ejaculation stage I- seminal fluid expulsed from the seminal vesicles into the prostatic urethra.

Ejaculation stage II- seminal fluid expulsed from the prostatic urethra to the urethral meatus.
Final phase- (resolution)- immediately after orgasm, rapid loss of vasocongestion and decrease in penis size.

Resolution – refractory periods- unable to be re-stimulated to another orgasm, even if the penis remains erect.

Question 4

Describe phases of sexual response in women

Answer 4

Excitement phase- vasocongestion causes clitoral enlargement and vaginal lubrication. The vaginal orifice opens; Increases HR, BP, and increased blood flow to genitals.

Plateau phase- retraction of clitoris under clitoral hood, vagina expands in width and depth, rising of cervix and uterus.

Orgasmic phase- Increases HR, RR, BP.

Resolution phase- clitoris returns to normal size and position, vasocongestion dissipates.
No obligatory refractory period.

Question 5

Describe the two types of Impotence:

Answer 5

Primary:never achieved an erection necessary for intercourse.

Secondary: has experienced erections in past but subsequent difficulty. Treatment with sildenafil citrate (Viagra)

Question 6

Problems with ejaculation:

Answer 6

subjective response of both partners dependent on levels of satisfaction.

o (Primary) physiological disturbances.

o (secondary) interpersonal problems, lumbar sympathectomy, antiadrenergic drugs (guanethidine, methyldopa)

Question 7

Dyspareunia:

Vaginismus:

Answer 7

Dyspareunia- (painful intercourse) lack of lubrication, inadequate sexual arousal, drugs, decreased estrogen and infections.

Vaginismus- involuntary contractions, painful penetration.

Question 8

Age-related sexual problems-

Answer 8

climacteric- period between middle to old age which has significant sexual changes.
Thinning of vaginal tissues, slower arousal,
fewer spontaneous erections, chronic diseases, medication usage,
decreased mobility and body image changes.

Question 9

Symptoms of menopause

Answer 9

ovarian secretion of the hormones estrogen and progesterone is halted, resulting in changes in tissues dependent on these hormones.

Estrogen-responsive tissues are found in the female genital organs, breast tissue, pituitary gland, hypothalamus.

Changes include decrease in thickness of vaginal wall, decrease in vaginal secretions, vaginal and urethral atrophy, loss of bone density, and vasomotor clinical manifestation such as hot flashes.

nonhormonal drugs to relieve the clinical manifestations of menopause such as osteoporosis (Fosamax), vaginal dryness (water-soluble lubricants), and hot flashes (vitamin E).
Some women choose to use herbal therapy with black cohosh, ginseng, and dong quai for relief of clinical manifestations.

Question 10

Pros and cons of HRT

Answer 10

Estrogen reduces the risk of atherosclerosis, angina, coronary artery disease, and osteoporosis.

Estrogen increases risk for breast cancer and dysfunctional uterine bleeding.

When used alone without progesterone, there is an increased incidence of uterine cancer.

When used in combination with progesterone, may have menstrual periods.

Question 11

Uses for estrogen therapy

Answer 11

Estrogen may be given for treatment of ovarian failure, female hypogonadism, postmenopausal osteoporosis, inoperable breast and prostate cancers, atrophic vaginitis, and uterine conditions resulting from hormonal imbalance.

Question 12

Side effects of estrogen

Answer 12

Edema
Spotting between menstrual periods
Thromboembolism
Hypertension
Increase in weight
Breast tenderness
Dark skin patches that darken when exposed to the sun

Caffeine and smoking increase risks

Question 13

Contraindications and precautions of estrogen

Answer 13

Contraindicated in clients with history of breast cancer, except in cases when cancer is not dependent on estrogen

History of thromboembolitic disorders, hepatic or renal disorders, and undiagnosed vaginal bleeding (may increase risk of endometrial cancer)

Pregnancy

Hypersensitivity

Question 14

Drug interactions of estrogen

Answer 14

Anticoagulants: decrease anticoagulant

Antidiabetics: impair glucose tolerance that may change antidiabetic drug requirements

Anticonvulsants: estrogen-induced fluid retention may precipitate seizures

Barbiturates: decrease effect of estrogen

Corticosteroids: increase risk of toxicological effect of corticosteroids

Rifampin: decreases effect of estrogen

Question 15

Why should tetracycline be avoided during pregnancy

Answer 15

Tetracycline hydrochloride should not be given to pregnant women in the last half of their pregnancy (or not at all) because it may permanently discolor the teeth, cause enamel defects, or retard bone growth of the fetus.

Question 16

Adnexa:

Answer 16

ovaries and fallopian tubes together are referred to as the Adnexa

Question 17

Vas deferens —

Ejaculatory ducts —

Seminal vesicles —

Answer 17

Vas deferens —a long, muscular tube that travels from the epididymis into the pelvic cavity, to just behind the bladder. The vas deferens transports mature sperm to the urethra.

Ejaculatory ducts —formed by the fusion of the vas deferens and the seminal vesicles; empty into the urethra.

Seminal vesicles —sac-like pouches that attach to the vas deferens near the base of the bladder. The seminal vesicles produce a sugar-rich fluid (fructose) that provides sperm with a source of energy and helps with the sperms’ motility. The fluid makes up most of the volume of a man’s ejaculate.

Question 18

Follicular phase

Answer 18

1 Follicular phase - This phase starts on the first day of your period. During the follicular phase of the menstrual cycle, the following events occur:

• Two hormones, follicle stimulating hormone (FSH) and Luteinizing hormone (LH) are released to travel to the ovaries. The hormones stimulate growth of about 15-20 eggs in the ovaries each in its own “shell,” called a follicle. These hormones also trigger an increase in the production of the female hormone estrogen. As estrogen levels rise, like a switch, it turns off the production of FSH.
• As the follicular phase progresses, one follicle in one ovary becomes dominant and continues to mature. This dominant follicle suppresses all of the other follicles in the group. As a result, they stop growing and die. The dominant follicle continues to produce estrogen.

Question 19

Ovulatory phase -

Answer 19

2 The ovulatory phase, or ovulation, starts about 14 days after the follicular phase started. The ovulatory phase is midpoint of menstrual cycle, with next menstrual period starting about 2 weeks later. During this phase, the following events occur:

• The rise in estrogen from the dominant follicle triggers a surge in amount of Luteinizing hormone (LH) that is produced by the brain.
This causes the dominant follicle to release its egg from the ovary.

• As the egg is released (a process called ovulation) it is captured by finger-like projections on the end of the fallopian tubes (fimbriae). The fimbriae sweep the egg into the tube.
• Also during this phase, there is an increase in the amount and thickness of mucus produced by the cervix (lower part of the uterus.) If a woman were to have intercourse during this time, the thick mucus captures the man’s sperm, nourishes it, and helps it move towards the egg. Fertilization usually takes place in the middle portion of the fallopian tube (ampulla).
• Secretory- (progestational, luteal, premenstrual) dominance of progesterone from the corpus luteum causes the endometrium to become dilated with glycogen and mucin.

Question 20

Luteal phase of menstration

Answer 20

The luteal phase begins right after ovulation and involves the following processes:

• Once it releases its egg, the empty follicle develops into a new structure called the corpus luteum.
• The corpus luteum secretes the hormones estrogen and progesterone. Progesterone prepares the uterus for a fertilized egg to implant.
• If intercourse has taken place and a sperm has fertilized the egg, the fertilized embryo will travel through the fallopian tube to implant in the uterus. If egg not fertilized, it passes through uterus. Not needed to support a pregnancy, the lining of the uterus breaks down and sheds, and next menstrual period begins.

Question 21

Ovaries and uterus each have 3 different cycles:

Answer 21

Ovarian Cycles: Follicular (occurs during the menstrual and proliferative phase), Ovulation, Luteal Phase

Uterine Cycles: Menstrual a d Proliferative (both occur during the follicular phase), Secretory Phase

Question 22

Prostate gland —

Bulbourethral glands —

Answer 22

Prostate gland —a walnut-sized structure located below the urinary bladder in front of the rectum; contributes additional fluid to the ejaculate; fluids help to nourish sperm. The urethra runs through the center of the prostate.

Bulbourethral glands —Cowper’s glands: pea-sized structures located on the sides of the urethra just below the prostate gland; produce a clear, slippery fluid that empties directly into the urethra. This fluid lubricates the urethra and neutralizes acidity due to residual drops of urine in the urethra.

Question 23

Menorrhagia –
Metrorrhagia –
Menometrorrhagia –

Answer 23

Menorrhagia – prolonged or excessive bleeding in early life may be due to endocrine disturbance – later life due to inflammatory disturbances, tumors or hormonal imbalance.

Metrorrhagia – bleeding between regular menstrual periods may signal cancer, benign tumors of uterus or other BYN problems; condition warrants early Diagnosis and treatment

Menometrorrhagia – Heavy vaginal bleeding between and during periods; requires evaluation.

Question 24

Fibroids:
Endometriosis:
Adenomyosis:

Answer 24

Fibroids (Leiomyomas & Myomas): Myomatous tumors of the uterus almost always benign (99.5%) Common – 20% of white ♀, 40-50% African-Amer. ♀. Develop slowly between ages of 25-40.

Endometriosis –benign lesions with cells similar to lining of the uterus grow in the pelvic cavity outside the uterus. Extensive growth may cause symptoms – 3-5 million ♀ affected – major cause of infertility. Nulliparous 25-35 yo.

Adenomyosis-tissue that lines the endometrium invades the uterine wall. Highest incidence in ♀ 40-50.

Question 25

Breast Cancer Mass Malignant Tumor:

Breast Cyst – Benign Mass of Fibrocystic Disease:

FibroadenomaBenign Breast Lump:

Answer 25

Breast Cancer Mass Malignant Tumor: Usually as a single mass(lump) in one breast; Usually nontender; irregular shape; farm, hard, embedded in surrounding tissue; referral and biopsy indicated

Breast Cyst – Benign Mass of Fibrocystic Disease: Occur as single/multiple lumps, 1/both breasts; Tender-increasing during premenstrual period; round shape, soft or firm, mobile; referral and biopsy

Fibroadenoma Benign Breast Lump: Occurs as single mass ♀ 15-35 yo, usually nontender; may be round or lobular; firm, mobile, not fixed; no premenstrual changes, referral and biopsy indicated

Question 26

• Transurethral Resection (TUR or TURP) TURP:
• Prostatectomy:
• Transurethral Incision (TUIP):

Answer 26

• Transurethral Resection (TUR or TURP) TURP- removal of the prostate in small chips.
• Prostatectomy – Suprapubic-abdominal incision, Perineal-incision thru perineum, Retropubic abdominal incision
• Transurethral Incision (TUIP)for treatment of BPH-to reduce urethral constriction

Question 27

Cryptorchidism:

Orchitis:

Answer 27

Cryptorchidism: congenital condition-undescended testes

Orchitis: inflammation of testes caused by pyogenic-viral-spirochete-parasitic-traumatic-chemical or unknown

Question 28

Epididymitis:

Hydrocele:

Varicocele:

Answer 28

Epididymitis: infection usually descends from infected prostate or UTI, or complication of ST

Hydrocele:collection of fluid in the tunica vaginalis of the testis, although it may occur in the spermatic cord

Varicocele: abnormal dilation of the veins of the pampiniform venous plexus in the scrotum

Question 29

Risks for Testicular Cancer

Answer 29

• -common cancer in ♂ 15-35, 2 nd most common in 25-39 yo - risk is 35 times greater in men with undescended testis or prenatal exposure to DES.

Question 30

Vasectomy

Answer 30

male sterilization – ligation and transection of part of the vas deferens with or with removal of a segment of the vas to prevent the passage of sperm from the testes

Question 31

Phimosis:

Priapism:

Answer 31

Phimosis - foreskin constricted - cannot be retracted; occur congenitally or from inflammation & edema

Priapism: uncontrolled, persistent erection occurring from either neural or vascular causes medications, sickle cell thrombosis, leukemic cell infiltration, spinal cord tumors, tumor invasion of penis or vessels

Question 32

Cancer of the Penis -

Answer 32

Male over 60, 0.5% of malignancies in US; can involve glans, body, urethra and lymph nodes

Question 33

Peyronie’s Disease:

Urethral Stricture:

Circumcision:

Answer 33

Peyronie’s Disease: buildup of fibrous plaques in sheath of corpus cavernosum causing curvature of erect penis

Urethral Stricture: section of urethra is narrowed – congenital or from scarring – treatment involves dilation or removal

Circumcision: excision of the foreskin or prepuce, of the glans penis

Question 34

o Basal Body Temperature:

o Billings Method:

o Symptothermal method:

Answer 34

o Basal Body Temperature: Approx. 24 hours before ovulation the temp dips slightly and then rises sharply within 24 hours.

o Billings Method: relies on changes in cervical mucous

o Symptothermal method: combines both of the above methods.

Question 35

What happens in male arousal?

Answer 35

Penile blood vessels become engorged and an erection is achieved.
The vas deferens is the internal structure through which the semen passes from the testes to the urethra. Its shape is unaffected by sexual arousal.
The parasympathetic nerves are stimulated during sexual arousal, not the sympathetic nerves.
The prepuce, or foreskin, does not increase in length during arousal.

Question 36

Hormones of ovulation

Answer 36

Gonadotropin-releasing hormone stimulates the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH rises first and LH follows. After ovulation, progesterone rises. In order to remember the hormones of the female menstrual cycle, it is important to know definitions, especially of prefixes and suffixes. Gonadotropin is a hormone that stimulates the gonads—that is, the ovaries or the testes. Follicle-stimulating hormone stimulates the follicle, or ovum sac, to mature, while luteinizing hormone stimulates the release of the ovum from the ovary and heralds the luteal phase of the menstrual cycle (when the corpus luteum is functioning). Finally, progesterone becomes elevated.

Question 37

When does progesterone elevate

Answer 37

Progesterone elevation occurs after ovulation and spikes at about 5-6 days after ovulation.
Progesterone is thermogenic—heat producing.
Progesterone is the reason why women’s temperatures are elevated following ovulation.

Question 38

What happens to estrogen and progesterone if pregnancy does not occur

Answer 38

When the ovum is not fertilized, both estrogen and progesterone levels drop.
The drop in hormones is followed by menstruation.
Menstruation begins the menstrual cycle.
Since pregnancy has not occurred, the nurse can deduce that the hormones of pregnancy need not remain elevated.

Question 39

What is spinnbarkeit?

Answer 39

Spinnbarkeit is defined as the “thread” that is created when the vaginal discharge is slippery and elastic at the time of ovulation. The changes are in response to high estrogen levels.
The woman inserts two fingers into her vagina and touches her cervix. After removing her fingers, she separates her fingers and “spins a thread” between her fingers.
When she is not in her fertile period, the mucus is thick and gluey. It is important to be familiar with self-help techniques to assist clients to understand their bodies.
Spinnbarkeit is a German term that literally means the ability to create a thread.

Question 40

What is mittelschmerz?

Answer 40

Women often feel a twinge, called mittelschmerz, near the site of the ovary at the time of ovulation.
Breast tenderness and mittelschmerz often occur at the time of ovulation.
Breast tenderness and mittelschmerz are symptoms of ovulation, not of abnormal hormonal levels.

Question 41

When does meiosis occur?

Answer 41

Meiosis occurs during puberty. At the completion of oogenesis only 1 ovum is created. At the completion of spermatogenesis, 4 sperm are created. Each ovum contains the haploid number of chromosomes.
Be familiar with the fact that meiosis begins during puberty and that the ova age during the following years. This is the likely reason why women who attempt to become pregnant after 35 years of age have an increased incidence of infertility as well as an increased probability of becoming pregnant with a Down syndrome fetus.

Question 42

Where are sperm produced and what is their travel route?

Answer 42

The sperm are produced in the testes.
They then proceed to the epididymis where they mature.
The vas deferens is the conduit through which the sperm first travel during ejaculation.
The prostate, encircling the neck of the urethra, produces a fluid that protects the sperm, and, finally, the sperm exit the male body via the urethra.

Question 43

List and describe the three pregnancy periods:

Answer 43

Antepartum: from conception to the onset of labor

intrapartum: from the onset of labor to the first one to four hours after delivery of newborn and placenta
postpartum: refers to the six weeks after delivery of the newborn and placenta

Question 44

Sx of ectopic pregnancy

Answer 44

severe pain, dizziness, and nausea and vomiting.

Dyspareunia and menorrhagia are assessment findings of endometriosis.

An increase in abdominal size is found in ovarian cysts.

Question 45

One of the serious complications of gonorrhea:

Answer 45

Sterility, caused by scarring of the fallopian tubes during the course of the disease and resulting in strictures.

Question 46

Sx of toxic shock syndrome

Answer 46

One of the most pronounced sx of toxic shock syndrome is a sudden temperature elevation above 102°F.
Other sx include chills; muscle pain; vomiting and diarrhea; red, macular rash that looks like a sunburn; and hypotension.

The condition is not known to affect menses or to give rise to complaints of headache and dizziness.

Question 47

Magnesium toxicity can occur from magnesium sulfate therapy. Signs of magnesium sulfate toxicity

Answer 47

Toxicity signs relate to central nervous system depressant effects of the medication and include:
respiratory depression, loss of deep tendon reflexes, and a sudden drop in fetal heart rate and maternal heart rate and blood pressure.

Normal magnesium level 1.5-2.5.
Therapeutic serum levels of magnesium are 4 to 7.5 mEq/L.

Question 48

Uses for mg sulfate

Answer 48

Magnesium sulfate is a central nervous system depressant and relaxes smooth muscle, including the uterus.
It is used to halt preterm labor contractions and is used for preeclamptic clients to prevent seizures.
Adverse effects include flushing, depressed respirations, depressed deep tendon reflexes, hypotension, extreme muscle weakness, decreased urine output, pulmonary edema, and elevated serum magnesium levels.

Question 49

Blood type in pregnancy

Answer 49

Type O persons produce both anti-A and anti-B antibodies. Type AB persons produce no antibodies. Type A and type B persons produce the antibody to the opposite type. For example, a type B person would produce anti-A antibodies. ABO incompatibility occurs when a type O mother is pregnant with a type A or type B fetus. The mother may develop antibodies that may result in hemolysis in the fetus and newborn. The infants may go on to develop hyperbilirubinemia, requiring phototherapy.

No ABO incompatibility occurs with a type AB mother regardless of the fetus’s blood type.

Question 50

Clinical manifestations of infants born to HIV-positive mothers:

Answer 50

Poor feeding, hypothermia, and signs of sepsis.

Diarrhea occurs in infection and sepsis. Infants of a mother with diabetes are of large size and weight. Chemical pneumonitis if a clinical manifestation of meconium aspiration syndrome.