Unitive PDF - Reproductive Health Concept

COLLEGE OF NURSING AND MIDWIFERY CONCEPT OF UNITIVE AND PROCREATIVE HEALTH A. UNITIVE It is not a simple physical union It is a specific type of physical union of a man and woman in natural intercourse. The act must be open to life...

COLLEGE OF NURSING AND MIDWIFERY CONCEPT OF UNITIVE AND PROCREATIVE HEALTH A. UNITIVE It is not a simple physical union It is a specific type of physical union of a man and woman in natural intercourse. The act must be open to life and towards procreation The unitive meaning is only found in natural intercourse between a man and a woman Therefore all other types of sexual acts are non-unitive and therefore, basically evil even between partners B. PROCREATIVE Is found only in natural intercourse. Even if each natural sexual act does not produce new life. New life is necessary in order to have a good moral object of the procreative meaning Every sexual act that is not ordered towards protection is a basically evil act Creation of new human person by the act of sexual intercourse by a man and a woman REPRODUCTIVE DEVELOPMENT INTRAUTERINE DEVELOPMENT Intrauterine- interval of life between conception and birth sex assigned at birth is generally determined at the moment of conception by chromosome information o sperm + ovum=new life gonad- body organ that produces the cells necessary for reproduction o ovary and testes 5 WEEKS o Mesonephric (wolffian) and paramesonephric (mullerian) ducts the tissue are already formed Week 7 or 8 o In chromosomal male, early gonadal tissue begins formation of testosterone o under the influence of testosterone the mesonephric duct develop into male reproductive organ then the paramesonephric regresses Week 10 o If testosterone is not available, the paramesonephric duct become dominant then develop into female reproductive organ o When ovaries form, oocytes ( cell will develop into egg) are already present 1|Page (+63) 967-552-1178 [email protected] Burgos Avenue, Cabanatuan City  COLLEGE OF NURSING AND MIDWIFERY Week 12 o External genitals begin to form o Male: Chromosomal male penile tissue, elongates and the ventral surface of the penis closes to form urethra o Female: Chromosomal female, uterus, labia minora= and majora form o For some reason if testosterone is halted in utero a chromosomal male could be born with female-appearing genitalia (ambiguous genitalia PUBERTAL DEVELOPMENT Puberty- stage of life where secondary sex changes begin female: in most chromosomal female, these changes are stimulated when the hypothalamus synthesizes and releases GnRH which triggers the anterior pituitary gland to release FSH and LH o FSH and LH are gonadotropin not only begin production of androgen and estrogen that initiates secondary characteristic but also cause the production of eggs and influence menstruation Hypothalamus- serve as gonadostat o Not proven but: general consensus is a person must reach a critical weight of approx. 95 lbs. (43 kgs) or develop a critical mass of body fat before the hypothalamus is triggered to send initial stimulation to the anterior pituitary gland to begin formation of FSH and LH The Role of Androgen Androgenic hormones are responsible for muscular development, physical growth and increase in sebaceous gland secretion cause acne in adolescent The level of primary androgenic hormone, testosterone one, is low until puberty (12-14) o Male: ▪ in chromosomal male, produced by adrenal cortex and testes ▪ when rises: changes testes, scrotum, penis, prostate, seminal vesicle, ▪ appearance of pubic, axillary and facial hair ▪ laryngeal enlargement→voice change ▪ maturation of spermatozoa ▪ closure of growth plates long bones everything termed adrenarche o Female ▪ In chromosomal female, produced by adrenal cortex and ovaries ▪ Enlargement of labia majora and clitoris and the formation of axillary and pubic hair 2|Page (+63) 967-552-1178 [email protected] Burgos Avenue, Cabanatuan City  COLLEGE OF NURSING AND MIDWIFERY The Role of Estrogen Female: When triggered at puberty by FSH, ovarian follicle begin to excrete a high level of the hormone estrogen o This increases the development of the uterus, fallopian tube, and vagina; typical fat distribution; hair patterns and breast development, closes epiphyses o Thelarche- the beginning of breast enlargement, usually start 1-2 years before menstruation Male: Estradiol in men is essential for modulating libido, erectile function, and spermatogenesis SECONDARY SEX CHARACTERISTICS Adolescent sexual development occurs in stages Chromosomal Female Growth spurt Increase in transverse diameter of pelvis Breast development Growth in pubic hair Onset of menstruation o Menarche starts on 12.4 years of age o Menstruation don’t begin in regular until ovulation occurs consistently and this does not tent to happen until 1 to 2 years after menarche o Production of ova stops in menopause Growth of axillary hair Vaginal secretion Chromosomal Male Increase in weight Growth of testes Growth of face, axillary and pubic hair Voice change Penile growth Increase in height spermatogenesis (production of sperm) o Unlike ova spermatozoa do not begin in intrauterine life and are not produce in cyclic pattern rather in continuous process o Sperm production continuous from puberty throughout life 3|Page (+63) 967-552-1178 [email protected] Burgos Avenue, Cabanatuan City  COLLEGE OF NURSING AND MIDWIFERY MALE REPRODUCTIVE SYSTEM Although the structure of reproductive system associated with XY and XX chromosome differ greatly in both appearance and function they are homologues; that is they arise from the same or matched embryonic origin Andrology- the study of XY (male) reproductive organ A. MALE EXTERNAL STRUCTURE Testes which encased in scrotum and penis The Scrotum Ru-gated skin-covered muscular pouch suspended from perineum its function: support testes and help regulate temperature of sperm cold-it contracts hot-it relaxes The Testes two ovoid glands 2 cm to 3 cm wide Rest in scrotum Each is encased by protective fibrous capsule and is composed of a number lobules o Lobules contains interstitial cell (Leydig cells) that produce testosterone and seminiferous tubule that produces spermatozoa Testes in fetus first form in the pelvic cavity then descend in late intrauterine life onto the scrotal sac o Must be monitored after birth to be curtained that it descend in what would have been the 34th to 38th week of gestation age Cryptorchidism- testes that remain in the pelvic cavity FSH- release androgen binding hormone (ABH) LH responsible for the release of testosterone from testes ABH and testosterone combine to promote sperm formation normal testes feel firm and smooth and are egg in shape The Penis composed of three cylindrical masses of eretile tissue in penis shaft urethra passes through the layer slowing penis serve as outlet for urinary and reproductive tract with sexual excitement nitric oxide release from the endothelium of blood vessels causes dilation and increase in 4|Page (+63) 967-552-1178 [email protected] Burgos Avenue, Cabanatuan City  COLLEGE OF NURSING AND MIDWIFERY blood flow to arteries in penis (engorgement) the ischiocavernosus muscle at the base of penis under stimulation of parasympathetic NS, then contracts and trapping both venous and arterial blood in three section of erectile tissue causes distention and erection glans- located at the distal end of penis which is a bulging, sensitive ridge of tissue it was protected by prepuce o prepuce- retractable casing of skin this is removed surgically though circumcision o circumcision reduce having STI and penile cancer THE MALE INTERNAL STRUCTURE These are epididymis, vas deferens, seminal vesicle, ejaculatory ducts, prostate glands, bulbourethral glands, urethra Epididymis Seminiferous tubule leads to a tightly coiled tube---epididymis Responsible for conducting the sperm to vas deferens then next to the outside body Since it is tightly coiled its length is deceptive, over 20 ft Some sperm stored in here but immobile o It take 12-20 days to completely travel the epididymis and 65-75 to reach full maturity o These is the reason why aspermia and oligospermia does not respond to therapy but occurred after 2 months ▪ Aspermia- absence of sperm ▪ Oligospermia- fewer than 20 million sperm per millimeter The Vas Deferens (Ductus Deferens) Additional hollow tube surrounded by arteries and veins and protected by thick fibrous coating---spermatic cord It carries sperm from epididymis to the inguinal canal to abdominal cavity ends at seminal vesicle and ejaculatory duct below bladder Sperm complete maturation as pass through vas deferens Still immobile but probable because of fairly acidic medium of semen The Seminal Vesicle Two convoluted pouches that lie along lower portion of bladder and empty into the urethra by ejaculatory duct It secret viscous alkaline liquid with a high sugar, protein and prostaglandin Sperm became mobile because of the fluid and pH favorable environment 5|Page (+63) 967-552-1178 [email protected] Burgos Avenue, Cabanatuan City  COLLEGE OF NURSING AND MIDWIFERY The Prostate Gland Chestnut-sized gland that lies just below bladder that allow urethra tp run through it like doughnut Purpose is secrete thin alkaline fluid further protects sperm by increasing naturally low pH level of the nature The Bulbourethral Glands Two bulbourethral, or Cowper, glands lie beside prostate gland and empy by short duct into urethra Supply more alkaline fluid to help ensure safety of passage of spermatozoa Semen therefore derived from: o Prostate gland- 60% o Seminal vesicle- 30% o Epididymis-5% o Bulbourethral gland-5% The Urethra Hollow tube leading from the base of bladder which after passing through the prostate gland continue to to the outside through shaft and glans of penis About 8 in (18 cm-20 cm) Line with mucous membrane THE FEMALE REPRODUCTIVE SYSTEM The XX RS Has both internal and external components. The study of female RS is gynecology A. FEMALE EXTERNAL STRUCTURE Structure form the female external genitalia are vulva, mons veneris, labia minora and majora, vestibule, clitoris, prepuce, skene glands and Bartholin glands, fourchette, perineal body/muscle and hymen The Mons Veneris the pad of adipose tissue located over the pubic symphysis and the pubic bone joint covered by coarse, curly hairs its purpose is to protect the junction of pubic bone from trauma The Labia Minora posterior to mons veneris spread two hairless folds of connective tissue vary greatly in size and shape before menarche: folds are fairly thin childbearing age: increase size and thickness 6|Page (+63) 967-552-1178 [email protected] Burgos Avenue, Cabanatuan City  COLLEGE OF NURSING AND MIDWIFERY  after menopause: they atropy and again become much smaller normally: pink in color, internal surface covered with mucous membrane and external surface with skin abundant with sebaceous glands cause possible localized sebaceous cysts The Labia Majora two folds of tissue, fused anteriorly bt separated posteriorly positioned lateral to labia minora composed of loose connective tissue and covered with epithelium tissue and pubic hair protect the external genitalia, shiled the outlets to urethra and vagina Vestibule flattened smooth surface where the opening of bladder (urethra) and uterus (vagina) arise from Clitoris external clitoris is the rounded organ of erectile tissue covered with prepuce sensitive to touch and temperature center of sexual arousal and orgasm internal component is clitoral crura arterial blood flow supply is plentiful when ischiocavernosus muscle surrounding t contracts with sexual arousal venous flow for clitoris is blocked and leads to clitoral erection as crura and corpus cavernosum tissue as well Skene Gland and Bartholin Gland skene gland (paraurethral glands)- located between urinary meatus; ducts open into urethra Bartholin glands (vulvovaginal glands)- located on each side of vagina and it ducts open into the proximal vagina ear labia minora and hymen Secretion from both glands lubricates external genitalia during coitus o Coitus- sexual intercourse Fourchette Ridge of tissue formed by posterior labia minora and majora Structure that tears (laceration) cut (episiotomy) during childbirth to enlarge vaginal opening Perineal Body/Muscle Posterior to fourchette Stretches during childbirth to allow enlargement of vagina and passage of fetal head Exercise: Kegel exercise, squatting, tailor sitting makes it flexible to allow optimal expansion and prevent tearing of 7|Page (+63) 967-552-1178 [email protected] Burgos Avenue, Cabanatuan City  COLLEGE OF NURSING AND MIDWIFERY muscle Hymen Tough but elastic semicircle of tissue that covers opening of vagina during childhood Often torn during first sexual intercourse Hematocolpometra- Female has imperforate hymen or hymen so complete that it does not allow passage of menstruation and vagina until surgically incised THE VULVAR BLOOD AND NERVE SUPPLY BLOOD SUPPLY o Blood supply of external genitalia is mainly from pudendal artery and portion from anterior rectus artery o Pressure on these veins by fetal head are crucial as it can cause extensive back pressure and development of varicosities (distended veins) in labia majora and legs NERVE SUPPLY o Anterior portion of the vulva derives its nerve supply from the ilioinguinal and genitofemoral nerves (L1 level) o The posterior portion of the vulva and vagina supplied by the pudendal nerve (S3 level) o These rich nerve cause area extremely sensitive to touch, temperature, pressure and pain o At time of birth normal stretching of perineum causes temporary loss of sensation limiting amount of pain during childbirth FEMALE INTERNAL STRUCTURE These includes the ovaries, fallopian tube, uterus and vagina The Ovaries 3 cm long, 2 cm in diameter and 1.5 cm thick, size and shape of almond Grayish-white in color and appear pitted with minute indentions on the surface Function: o Produce mature and discharge ova (the egg cell) o In process of producing ova it also produce estrogen and progesterone and initiate and regulate menstruation cycle o Held suspended and in close contact at the end of fallopian tube by three strong ligaments attach on both to uterus and pelvic wall not covered by layer of peritoneum ▪ Ova readily escape and make way to uterus thru fallopian tube The Division of Reproductive Cell (Gametes) The Fallopian Tube Approx.. 10 cm long in mature person 8|Page (+63) 967-552-1178 [email protected] Burgos Avenue, Cabanatuan City  COLLEGE OF NURSING AND MIDWIFERY Function: o Convey ovum from the ovaries to the uterus and to provide place for fertilization of the ovum by sperm It is anatomically divided into 4 parts INTERSTITIAL PORTION o most proximal o lies within the uterine wall o 1 cm length ISTHMUS o 2 cm in length o Extremely narrow o Cut or sealed in tubal ligation or tubal sterilization AMPULLA o Longest portion of the tube o 5 cm in length o Portion of tube where fertilization of ovum occurs INFUNDIBULAR PORTION o Most distal segment o 2 cm long, funnel shape and covered by fimbria (small hairs) ▪ Fimbria- helps to guide ovum to fallopian tube Linig of fallopian tibe is composed of mucous membrane which contains both mucous-secreting cells and ciliated cells Beneath is connective tissue and circular muscle o Muscles help produce peristaltic motion helps conduct ovum to the length of the tube o Mucus may serve as nourishment for fertilized egg because it contains protein, water and salt Fallopian tube are open at their distal end makes possible of conception o Can also lead to infection if germ spread frp, perineum thru the uterus and tubes to pelvic cavity (peritonitis) o Clean teaching technique must be used during pelvic examination o During labor and birth sterile technique is done to ensure that no organism can enter by this (fallopian tube) route. The Uterus hollow muscular pear shaped organ located in the lower pelvic posterior to bladder and anterior to rectum Function: o Receive ovum from fallopian tube o Provide place for implantation and nourishment 9|Page (+63) 967-552-1178 [email protected] Burgos Avenue, Cabanatuan City  COLLEGE OF NURSING AND MIDWIFERY o Furnish protection to a growing fetus o At maturity if the fetus expel it from a person body With maturity o 5-7 cm long, 5 cm wide and at widest part 2.5 cm deep Non pregnant state o weight approx. 60 g After pregnancy o uterus never return to exactly its nonpregnant state but remain approx.. 9 cm long, 6 cm wide, 3 cm thick and 80 g in weight IT CONSISTS OF THREE DIVISION: 1. Body or corpus a. Uppermost part and forms the body of the organ b. The cavity’s lining is continuous with fallopian tube the portion between the two is termed fundus i. During pregnancy: fundus can be palpated to determine amount of uterine growth ii. During labor/birth: measure uterine force of contraction iii. After birth: assess that uterine is returning to its nonpregnant state c. The body of uterus is the portion that expands during pregnancy and contains the growing fetus 2. Isthmus a. segment between the body and the cervix b. AKA lower uterine segment c. Segment where most incision is made for cesarian section 3. Cervix a. Lowest portion of the uterus b. its central cavity is termed as central canal i. internal cervical os- opening of the canal at junction of cervix and isthmus ii. external cervical os- distal opening to the vagina c. the level of the external os is at eh level of the ischial spine (an important relationship in estimating the level of the fetus in the birth canal at the time of birth) UTERINE AND CERVICAL COATS Uterine consist of three separate coats or layers of tissue: 1. Endometrium, inner layer of mucus membrane 10 | P a g e (+63) 967-552-1178 [email protected] Burgos Avenue, Cabanatuan City  COLLEGE OF NURSING AND MIDWIFERY Consist of two layer of cell o basal layer ▪ closest to the uterine wall ▪ stable not influence by hormones o grandular cell ▪ greatly influence by estrogen and progesterone ▪ grows and becomes thick ▪ responsive each month under influence of hormones that becomes capable of supporting pregnancy ▪ if no pregnancy it is the layer that shed as the menstrual flow endocervix o the mucus membrane that lines the cervix o cells are affected by hormones. Cells secret mucus to provide alkaline, lubricate surface to reduce acidity and aid passage of spermatozoa thru cervix o efficiency of secretion depends on stimulation ▪ estrogen at its peak- as many as 700 ml of mucus per day ▪ estrogen in lowest- few millimeters produced ▪ during pregnancy- so much secretion that endocervix is plugged with mucus forming seal to keep out ascending infection (operculum) both lower outer surface of the cervix and internal cervical os are not lined with mucous membrane but with stratified squamous epithelium o locating the point of tissue where it changes to epithelium to mucous membrane is important in obtaining Papanicolaou smear because this tissue is dynamic in cellular growth and is often origin of cervical cancer 2. Myometrium, middle layer of muscle fiber Or the muscle layer of uterus Composed of three interwoven layers of smooth muscle (longitudinal, transverse, oblique) o Intertwining network of fiber offers extreme strength to organ so when uterus contracts at end of pregnancy to expel feyus equal pressure exerted at all direction thoughout cavity It also constrict fallopian tube at the point they enter fundus peventing regurgitation of menstrual blood into the tube Also holds the internal cervical os closed during pregnancy to prevent preterm birth After child birth- interlacing network constrict blood vessels limiting amount of blood loss 11 | P a g e (+63) 967-552-1178 [email protected] Burgos Avenue, Cabanatuan City  COLLEGE OF NURSING AND MIDWIFERY 3. Perimetrium, outer layer of connective tissue Add further strength and support to the organ UTERINE BLOOD SUPPLY large descending abdominal aorta divides to form two iliac arteries: hypogastric arteries and uterine arteries→supply uterus guaranteed to be copious and adequate to supply the growing needs of a fetus o uterine blood supply is not far removed from the aorta o after supplying the ovaries with blood, the ovarian artery (a direct subdivision of the aorta) joins the uterine artery and adds more blood to the uterus. Prepared By: Aleli Anne S. de Lara, RN 12 | P a g e (+63) 967-552-1178 [email protected] Burgos Avenue, Cabanatuan City