reproduction

Question 1

ovary function

Answer 1

produce hormones estrogen and progesterone

site of ovum (egg cell) development and ovulation

Question 2

fallopian tubes function

Answer 2

carry the ovum from the ovary to the uterus

usually the site of fertilization

Question 3

fimbriae function

Answer 3

sweep the ovum into the fallopian tube following ovulation

Question 4

uterus function

Answer 4

pear-shaped organ in which the embryo and fetus develop

involved in menstruation

Question 5

cervix function

Answer 5

separates the vagina from the uterus
holds the fetus in place during pregnancy
dilates during birth to allow the fetus to leave the uterus

Question 6

vagina function

Answer 6

extends from the cervix to the external environment
provides a passageway for sperm and menstrual flow
functions as the birth canal

Question 7

testosterone

Answer 7

located in interstitial cells
stimulates spermatogenesis
promotes and regulates the development of secondary sexual characteristics
associated with sex drive levels

Question 8

follicle stimulate hormone (FSH)

Answer 8

located in pituitary gland

stimulates the production of sperm cells in the seminiferous tubules

Question 9

luteinizing hormone (LH)

Answer 9

located in the pituitary gland

promotes the production of testosterone by the interstitial cells

Question 10

gonadotropin releasing hormone (GnRH)

Answer 10

located in the hypothalamus

stimulates secretion of FSH and LH

Question 11

Ageing and the Female Reproductive System Female Menopause:Perimenopause

Answer 11

Transitional period between reproductive and non-reproductive years, lasting 2 to 8 years
5-10 years before menopause women note mild to extreme variability in frequency and quality of flow
Ovaries are still functioning, but function has started to decrease
Symptoms depend on the sensitivity of the target tissue receptors
Symptoms begin with a lengthening of the menstrual cycle which correlates with anovulatory cycles

Question 12

Menstrual and(An)ovulation cycles

Answer 12

It is possible for a woman to become pregnant even if she is showing signs of perimenopause, because she may still be ovulating
During each menstrual cycle, the body goes through complex hormonal changes that lead up to a process known as ovulation, when a mature egg is released from the ovary. After ovulation occurs, the empty egg follicle, now called a corpus luteum, produces the hormone progesterone. Progesterone helps support a possible early pregnancy.
If conception doesn’t occur, the corpus luteum breaks down and stops producing progesterone, which is what triggers the start of a period.
During an anovulatory cycle, a woman does not ovulate and therefore does not release an egg. A woman who is not ovulating is not able to get pregnant.

Question 13

Other common reasons for anovulation

Answer 13

Being overweight or obese
High levels of stress
Being underweight
Exercising too much
Hormonal imbalances of thyroid stimulating hormone (TSH) and prolactin
Polycystic ovary syndrome (PCOS)
Can be common during periods of hormonal transition.
A girl’s first few periods are usually anovulatory.
The first few periods after stopping birth control are often anovulatory, as is the time during perimenopause.
Many women also have an anovulatory cycle after miscarriage or after childbirth.

Question 14

menopause

Answer 14

Point in woman’s life when she is no longer fertile and menstrual periods stop
Menopause is defined as the absence of menstrual periods for 12 months
Average age for natural menopause is 51 years, but it can occur earlier or later
Considerations for Menopause:
Women who smoke tend to start menopause earlier–on average 2 years sooner than nonsmokers
Tends to be genetically predetermined and not affected by age at menarche, childbearing or lactation, use of oral contraceptives, socioeconomic class, or race
Thinner women experience earlier
Irregular menses in women in their early 40’s
Alcohol consumption – later menopause

Question 15

Menopause:Ovarian Changes

Answer 15

Estradiol levels remain normal to slightly elevated until about 1 year before menopause
At around 37 to 38 years women experience accelerated follicular loss until the supply is depleted
Correlates with an increase in Follicular Stimulating Hormone (FSH) and decrease in inhibin
Inhibin B is usually responsible for keeping FSH levels down

Question 16

hormones

Answer 16

Estradiol is produced by the ovaries
Estrogen is a generic term for three similar hormones; estradiol, estrone, and estriol. Estradiol is the most potent and plentiful.
Estrogen is needed for maturation of reproductive organs, development of secondary sec characteristics, closure of long bones after pubertal growth spurt, regulation of menstrual cycle and endometrial regeneration after menstruation.
Estrogen has metabolic effects on bones, liver, blood vessels, brain and CNS, kidneys and skin. After menopause, ovarian production of estradiol and estrone is greatly decreased leading to increased susceptibility to osteoporosis
Increase in FSH stimulation accelerates follicular loss and declining inhibin production disrupts the negative feedback influence over pituitary secretion of FSH
One of two hormones (inhibin-A and inhibin-B) secreted by the gonads (by Sertoli cells in the male and the granulosa cells in the female) – inhibit the production of follicle-stimulating hormone (FSH) by the pituitary gland
In women, follicle-stimulating hormone helps to mature the ovarian follicles that release the eggs. Men’s bodies use FSH to support the growth and development of sperm.
Without the release of FSH, a woman cannot continue her reproductive cycle, as her ovaries will not release an egg.
Purposes of FSH test:
Menopause testing: If a woman’s menstrual cycle has become irregular or she has not had her period at all, a doctor may order the test. If FSH levels are high, it could indicate menopause.
Female fertility testing: If a woman is not ovulating, her FSH levels might be either high or low, depending on the cause.
Male fertility testing: In men, FSH stimulates the growth of sperm cells. If a man’s FSH levels are high, it can mean the testicles are not functioning properly.

Question 17

Menopause: Uterine Changes

Answer 17

Proliferative growth of the endometrium
Longer exposure to estrogen and greater thickness of the endometrium, half of all women will experience dysfunctional uterine bleeding that is heavy and unpredictable

Question 18

Menopause: Systemic Changes

Answer 18

Vasomotor flashes are characterized by rise in skin temperature, dilation of peripheral blood vessels, increased blood flow in the hands, increased skin conductance, and transient increase in heart rate followed by a temperature drop and produce perspiration over the area of flash distribution
Dizziness, nausea, headaches, or palpitations may accompany the flush
Flushes vary in frequency, intensity and duration and experienced for 1 to 15 years
Rapid changes in estrogen levels can increase emotional stress with unpredictable mood swings, weight gain, migraine headaches, and insomnia
Lower estrogen levels will decrease skin thickness and diminish skin elasticity, increasing skin dryness and wrinkling

Question 19

Menopause: Breast Tissue Changes

Answer 19

Breast tissue becomes involuted
Fat deposits and connective tissue increase
Breasts are reduced in size and firmness

Question 20

Menopause: Urogenital Tract Changes

Answer 20

Ovaries shrink, the uterus atrophies and the vagina shortens, narrows and loses some elasticity
Lubrication in the vagina diminishes and vaginal pH increases creating higher incidence of vaginitis
Cervix atrophies, the cervical os shrinks, vaginal epithelium atrophies, labia major and minora become less prominent
Some pubic hair is lost
Urethral tone declines throughout the pelvic area– urinary frequency or urgency, UTI’s and incontinence may occur
Regular sexual activity and orgasm may diminish some of these changes
Sexually active women have less vaginal atrophy

Question 21

Menopause: Skeletal and Cardiac Changes

Answer 21

Skeletal:
Bone mass is lost, leading to increased brittleness and porosity and possibly osteoporosis
Cardiac Changes:
Risk of coronary heart disease increases significantly

Question 22

perimenopause

Answer 22

irregular menses
occasional vasomotor symptoms (hot flashes and night sweats)
atrophy of genitourinary tissue with decreased support
stress and urge incontinence
osteoporosis
mood changes

Question 23

post menopause

Answer 23

cessation of menses
vasomotor instability (night sweats and hot flashes)
atrophy of genitourinary tissue (eg. vaginal epithelium)
stress and urge incontinence
breast tenderness

Question 24

signs and symptoms of estrogen deficiency

Answer 24

vasomotor = night sweats, hot flashes 
genitourinary = atrophic vaginitis, dyspareunia secondary to poor lubrication, incontinence
psychological = emotional lability, change in sleep pattern, decreased REM sleep 
skeletal = increased fracture rate, especially of vertebral bodies but also of humerus, distal radius, and upper femur 
cardiovascular = decreased high density lipoproteins, increased low density lipoproteins 
dermatological = diminished collagen content of skin, breast tissue changes

Question 25

Based on signs and symptoms of estrogen deficiency

Answer 25

MSK assessment – Potential for fractures
CV assessment – Potential for increased risk of cardiovascular disease
Mental health assessment – Potential for impact on self, body image, confidence, stress
GU assessment – Potential incontinence, infections – can also impact self-esteem, isolation

Question 26

‘Male menopause’

Answer 26

Andropause – aging related hormonal changes in men
As men age, steady decline of testosterone levels starting at 30-40 years of age
Some men may experience some symptoms:
Reduced energy
Enlargement of breasts
Loss of body hair
Decline in sexual function (erections, sex drive)
Decreased bone density
Increased body fat/reduced muscle
Hot flashes (rare)
Irritability; trouble remembering; trouble concentrating; depression
Testosterone levels decrease gradually
Sperm production does not stop
Not all men experience low testosterone and sperm production

Question 27

Male Menopause?

Answer 27

The term “menopause” only pertains to the female condition when the ability to reproduce is halted.
Testosterone is the male sex hormone that is needed for growth of body hair, building strong bones and muscles, and producing sperm.
As men age, testosterone levels (T-levels) can decline because of medication, illness, injury or lifestyle factors. This drop in testosterone is inaccurately classified as “male menopause,” – more clinically referred to as testosterone deficiency syndrome, androgen deficiency of the aging male, and late-onset hypogonadism.

Question 28

BPH: Aging and the prostate

Answer 28

Occurs mainly in older men
Two theories:
With aging, the amount of testosterone decreases but the small amount of estrogen remains the same—higher proportion of estrogen which promotes prostate cell growth
Dihydrotestosterone (DHT)—male hormone that promotes prostate cell growth; produced and accumulated at high levels in prostate
Most common problem for men over 50: symptoms increase with age
Risk factors:
age 40 years and older
family history of benign prostatic hyperplasia
medical conditions such as obesity, heart and circulatory disease, and type 2 diabetes
lack of physical exercise
erectile dysfunction

Question 29

BPH: Symptoms

Answer 29

Lower urinary tract symptoms suggestive of benign prostatic hyperplasia may include
urinary frequency—urination eight or more times a day
urinary urgency—the inability to delay urination
trouble starting a urine stream
a weak or an interrupted urine stream
dribbling at the end of urination
nocturia—frequent urination during periods of sleep
urinary retention
urinary incontinence—the accidental loss of urine
pain after ejaculation or during urination
urine that has an unusual color or smell

Question 30

causes of BPH symptoms usually:

Answer 30

Blocked urethra

Bladder overworked trying to pass urine through the blockage

Question 31

potential complications of BPH

Answer 31

acute urinary retention
chronic, or long lasting, urinary retention
blood in the urine
urinary tract infections (UTIs)
bladder damage
kidney damage
bladder stones

Question 32

BPH patient care intervention

Answer 32

As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder. The narrowing of the urethra and urinary retention [inability to empty the bladder completely] cause many of the problems associated with benign prostatic hyperplasia.
Urinary Catherization may require a large, stiffer catheter – using a 16 Fr instead of usual 14Fr
Post removal of catheter — patient may have more difficulty voiding on own and may require In/Out catherization to prevent retention and infection

Question 33

diagnosis of BPH

Answer 33

History with symptoms
Digital rectal examination
Cystoscopy, transrectal ultrasonography as needed

Question 34

common medication for BPH

Answer 34

Tamsulosin (Flomax): Alpha blocker

Question 35

recognized STIs

Answer 35

Bacteria:
Chlamydia*
Gonorrhea*
Syphilis*
Chancroid
Genital mycoplasmas

Protozoa:
Trichomoniasis

 Viruses:
HIV
Herpes simplex virus, types 1 and 2
Cytomegalovirus
Viral hepatitis A and B
Human papillomavirus (HPV) –primary cause of cervical neoplasms

Parasites:
Pediculosis (may or may not be sexually transmitted)
Scabies (may or may not be sexually transmitted)

Question 36

infertility

Answer 36

Epidemiological studies categorize women as infertile if they have attempted to become pregnant without success without the use of contraceptives
Subfertile- prolonged time to conceive in contrast to sterility or the inability to conceive
Primary Infertility- woman who has never been pregnant
Secondary Infertility- a woman who has been pregnant in the past year
Infertility increases with the age of the woman, particularly those over 40 years of age
Diagnosis and treatment require considerable physical, emotional, psychological and financial investment over a period of time
Men and women view infertility differently
Therefore, defined as a diminished ability to conceive
If a woman is equal or younger than 35 and conception has not occurred in a 12-month timeframe during which sexual activity has occurred without contraception
If a woman is older than 35 and has not become pregnant after six months of trying
Infertility rates continue to increase (~ 16% of Canadian couples)
There is a connection between infertility rates and female partner’s age

Question 37

causes of infertility

Answer 37

30% of the time the cause is in men
40% of the time the cause is in women
20% of the time, the cause is a mix of factors from both male and female
10% of the time there is no specific cause that can be found
Sometimes it can be specific between these two people – their semen and mucus are not compatible
Each is tested with “donor” mucus and sperm respectively – no issues with donor then infertility issue is their sperm-mucus compatibility
Potential interventions:
“wash” sperm and artificially inseminate

Question 38

causes of infertility in women

Answer 38

Age – fertility decreased after 35 years of age
Problems producing eggs
Having an STI like chlamydia
Problems in the uterus
Problems with the fallopian tubes 
Endometriosis
Hormonal imbalances
Early menopause – before age 40

Question 39

causes of infertility in men

Answer 39

Poor “quality” sperm count: poor motility, dead
Low sperm count or lack of sperm
A history of STI like chlamydia
Hormonal imbalances

Question 40

causes of infertility in both men and women

Answer 40

Post treatments for cancer such as chemo, radiation, and or surgery
Chronic illnesses such as diabetes as well as their treatments
Tobacco and alcohol use
Being under weight or over weight

Question 41

ovarian factors affecting infertility in women

Answer 41

Developmental abnormalities
Anovulation- Primary
Pituitary or hypothalamic hormone disorder
Adrenal gland disorder
Congenital adrenal hyperplasia
Anovulation- Secondary
Disruption of hypothalamic - pituitary-ovarian axis
Amenorrhea after discontinuing oral contraceptive pills
Premature ovarian failure
Polycystic ovarian syndrome
Increased prolactin levels

Question 42

tubal/peritoneal factors affecting fertility in women

Answer 42

Developmental anomalies
Inflammation within the tube
Tubal adhesions
Reduced tubal motility
Endometriosis
PID

Question 43

uterine factors affecting fertility in women

Answer 43

Developmental anomalies
Endometrial and myometrial tumors
Asherman syndrome (uterine adhesions or scar tissue)
Vaginal-Cervical Factors
Other

Question 44

vaginal-cervical and other factors affecting fertility in women

Answer 44

Vaginal-Cervical Factors
Vaginal-cervical infections
Cervical mucus inadequate
Isoimmunization (development of sperm antibodies)
Other
Nutritional deficiencies (anemia)
Thyroid dysfunction
Obesity
Idiopathic condition

Question 45

pelvic inflammatory disease (PID)

Answer 45

Acute inflammatory process caused by infection
May involve any organ, or combination of organs of the upper genital tract
Pathophysiology:
Polymicrobial infection that is often initiated by chlamydia or gonorrhea
Can also be initiated by medical procedures involving the cervix such as abortions, dilatation and curettage (D&C)
Develops when pathogenic microbes ascend from infected cervix to infect the uterus
Chlamydia and gonorrhea induces changes in the epithelium, causing damage and facilitating invasion of other microorganisms
After one episode of pelvic inflammation, 15-20% of women develop long-term complications such as infertility, ectopic pregnancy, chronic pelvic pain, dyspareunia, pelvic adhesions, perihepatitis, and tubo-ovarian abscess
Deaths from PID are caused by septic shock

Question 46

clinical manifestations and nursing assessment of PID

Answer 46

Clinical Manifestations:
Manifestations vary from sudden, severe abdominal pain with fever to no symptoms at all
Asymptomatic cervicitis may be present for some time before PID develops
Onset may be bilateral abdominal pain characterized as dull and steady with a gradual onset
Symptoms are more likely to develop during or immediately after menstruation
Pain worsens with walking, jumping , or intercourse
May also include dysuria and irregular bleeding, increased or foul-smelling vaginal discharge
Potential complication – ectopic pregnancy
Nursing Assessment:
Subjective Data: health history, descriptions of clinical manifestations
Objective Data: fever, lymphadenopathy, gonorrhea (gram positive, smears, cultures and DNA amplification for Neisseria gonorrhoeae), chlamydia (positive culture of DNA amplification for chlamydia organisms)

Question 47

more on PID

Answer 47

PID can cause a wide variety of symptoms.
Some women can be very ill and have severe pain and fever. Others can have no obvious symptoms or even appear ill.
PID is not always easy to diagnose. Important that women seek medical attention if they have any risk factors for PID or symptoms of PID.
Bacteria can infect the Fallopian tubes and cause inflammation (salpingitis). When this happens, normal tissue can become scarred and block the normal passage of an egg, causing infertility.
If Fallopian tubes are partially blocked, an egg may implant outside the uterus and cause a dangerous condition called an ectopic pregnancy. An ectopic pregnancy can cause internal bleeding and even death. Scar tissue may also develop elsewhere in the abdomen and cause pelvic pain that can last for months or years.

Question 48

A number of factors might increase risk of pelvic inflammatory disease, including:

Answer 48

Being a sexually active woman younger than 25 years old
Having multiple sexual partners
Being in a sexual relationship with a person who has more than one sex partner
Having sex without a condom
Douching regularly, which upsets the balance of good versus harmful bacteria in the vagina and might mask symptoms
Having a history of pelvic inflammatory disease or a sexually transmitted infection
There is a small increased risk of PID after the insertion of an intrauterine device (IUD). This risk is generally confined to the first three weeks after insertion.

Question 49

Symptoms of pelvic inflammatory disease can include:

Answer 49

pain in the lower abdomen (the most common symptom)
pain in the upper abdomen
fever
painful sex
painful urination
irregular bleeding
increased or foul-smelling vaginal discharge
tiredness

Question 50

some factors affecting infertility in men

Answer 50

Hypospadius-opening of the urethra is on the underside of the penis
Testicular atrophy
Variococele- varicose vein on the spermatic vein in the groin due to compromised valves which allow for accumulation of blood in vessels- can be surgically corrected if desired
Retrograde ejaculation

Question 51

male infertility

Answer 51

Hypospadius: results in lower sperm counts in men with this condition likely due to the ejaculatory disturbances
Often fixed in childhood, yet adult men may have sexual dysfunction as a result of the procedure
Testicular Atrophy: occurs with steroid use, trauma, testicular torsion
Varicocele: Enlargement of veins in the scrotum which might increase temperature around testicle – if temperature too high can impact sperm development, motility and function
Common cause of low sperm production and decreased sperm quality
Retrograde ejaculation: occurs when semen enters the bladder instead of emerging through the penis during orgasm causing infertility
Urine with sperm can be collected and washed, then artificial insemination of the washed sperm