REPRODUCTIVE DISORDERS

CNCM 229 Care of Mother and Child-at-risk or with Problem

BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

● correction of hypospadias or cryptorchidism,

removal of labial adhesions, or surgical
OBJECTIVES
removal of an enlarged clitoris.

Reproductive disorders in children range from mild

PRECOCIOUS PUBERTY
infections to serious anatomic malformations. All these
disorders require prompt and careful treatment so
children can reach adulthood in good reproductive The appearance of physical and hormonal signs of
health, have unaltered fertility, and have a positive puberty at an earlier age. Precocious puberty
Unusually early development of secondary sexual
sense of sexuality. Reproductive infections may
characteristics and capability for sexual reproduction.
suggest child maltreatment, so children with these
need careful assessment to rule out this possibility. ● 2% of girls aged 6-8 years and 20% before age
(Dubowitz, 2013) six.
● Boys 9 years old
● types and causes:
Disorders Caused by Altered Reproductive ○ Central precocious puberty -
Development gonadotropin - dependent
○ Precocious pseudopuberty -
gonadotropin independent
AMBIGUOUS GENITALIA ○ CNS abnormalities: Tumors, CNS injury,
congenital anomalies
SIGNS:
refers to genitalia that is not defined as male or female,
and the presence or absence of gonadal tissue is ● Breast Development (Breast Buds)
unknown (Lathrop, Cheney, & Hayman, 2014). ● Pubic hair growth
● Increase in height
● Hips become broader
● Waist becomes thinner
● Sweaty and adult-like body odor
● Acne
● Vaginal Discharge
● Early Menarche (Onset of Menstruation)

CAUSES:

● Environmental factors such as exposure to

certain chemicals or pollutants
● Poor diet and nutrition
● Vitamin D deficiency
● Chronic stress
● Genetics and Hereditary factors
● Hypothyroidism or underactive thyroid gland
ASSESSMENT: ● Being overweight, which creates high estrogen
levels in the body
● Karyotyping or DNA analysis ● Problems with the endocrine glands.
● Laparoscopy
● Therapeutic Management

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REPRODUCTIVE DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

CAUSES:
FEMALE MALE

● The first and ● The earliest ● Ovarian Insufficiency

most obvious evidence of ● Hereditary
sign of early puberty is ● Underweight
puberty is usually testicular ● Nutritional Deficiencies
breast enlargement.
● Eating Disorders
enlargement, ● Growth of the
which may penis and ● Hormonal Imbalance
initially be scrotum typically
unilateral. occurs. INDICATION OF SPECIFIC DISORDERS:
● Pubic and axillary ● Accelerated
hair may appear linear growth ● Malnutrition or anorexia nervosa
before, at about (the pubertal
● Hypopituitarism or Turner Syndrome
the same time, or growth spurt)
well after the occurs later in
appearance of the course of MEDICAL EVALUATION:
breast tissue. male puberty
● Menarche is a than in female ● X-ray Bone test:
late event and puberty but often ○ Girls - 10.5 - 11 years old
does not usually occurs by the ○ Boys - 11.5 - 12 years old
occur until 2-3 time other
● Laboratory test:
years after the physical changes
onset of breast are noted. ○ Gonadotropins
enlargement. ○ Karyotype
● The pubertal ○ Magnetic resonance imaging (MRI)
growth spurt
occurs early in EMOTIONAL:
female puberty.
● No treatment if the child is healthy
DELAYED PUBERTY ● Treat the underlying cause
● Vitamin A and Iron Supplements
● Hormone Therapy
Delayed development of secondary sex
● Testosterone/Dihydrotestoster – for boys
characteristics.
● Estradiol and Progesterone – for girls
● Growth hormone
SIGNS:

● Lateness (first signs)

● No breast buds by age 13 years
● No menstrual flow by 16 years of age
● Underdeveloped uterus
● A slower rate of growth
● No testicular enlargement
● Discordance - delayed physical development

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REPRODUCTIVE DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

DISORDERS OF FEMALE REPRODUCTIVE

ORGAN DIDELPHUS

COGENITAL ABNORMALITIES OF THE FEMALE: Entirely double uterus i.e., two single-horned uteri.

HYPOPLASIA/AGENESIS

(uterus which is small in its totality), narrowing of the

cavity, uterine diverticula.

Treatment: hysteroscopy metroplasty

BICORNUATE

Two single-horned uteri.

HYPOPLASIA/AGENESIS

With a second blind-ending of the fallopian tube.

SEPTATE

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REPRODUCTIVE DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

ARCUATE
UTERINE SUPPORT DISORDERS:

Uterus slightly indented in the middle.

VAGINAL FISTULAS

DES - DRUG EXPOSURE

Exposure to DES during fetal life (DES-DIETHYL

ESTRADIOL).

CYSTOCELE

Cause by prolonged labor, multiple births, birth of a

large baby.

S/S: urinary frequency, urgency, incontinence, low

back pain.

TX: exercise, oral or topical estrogen, pessary.

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REPRODUCTIVE DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

S/S: constipation, difficult defecation, fullness in

vagina.

TX: diet counseling, stool softener, surgery.

URETHROCELE

Due to pressure of head on urethra and symphisis

pubis, familial, genetic.

S/S: asymptomatic, stress incontinence DISORDERS OF THE OVARIES:

TX: exercise.
CYSTIC LESIONS OF THE OVARIES

a persistent cystic enlargement of the corpus luteum

that is formed after ovulation and does not regress in
the absence of pregnancy.

RECTOCELE

Trauma to fascia and levatormuscles, usually cause by

childbirth.

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REPRODUCTIVE DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II
POLYCYSTIC OVARIAN SYNDROME (PCOS)
Common endocrine disorder affecting 5% to 10% of
women of reproductive age, and is a frequent source
of chronic anovulation.
Manifestation: Varying degrees of menstrual
irregularity, signs of hyperandrogenism (acne and
hirsutism or male-pattern hair loss), infertility, and
hyperinsulinemia or insulin resistance.
TX: lifestyle modification, weight loss, oral
contraceptive.
MENSTRUAL DISORDERS:
DEFINITION OF ABNORMAL MENSTRUAL BLEEDING
● Polymenorrhea - cycles shorter than 3wks
● Oligomenorhea - cycles longer than 6-7 wks
● Metrorrhagia - bleeding of light character
occurring irregularly between cycles
● Hypermenorrhea - excessive flow
● Menorrhea - prolong duration of flow
● Menoretrorrhagia - prolonged flow associated
with irregular and intermittent spotting between
bleeding episodes.
● Amenorrhea - absence of menstruation.
DYSMENORRHEA
Painful menstruation (refers to excessive pain during
menstruation).
TYPES:
Primary dysmenorrhea - associated with the release of
prostaglandins
S/S - begins on the 1-2 days before menstruation
(headache, diarrhea, fatigue, irritable, dizziness).
Secondary dysmenorrhea - related with pelvic
pathology
S/S - dull lower abdominal aches, spasmodic and
colicky in nature that radiates to lower back.
PRE - MENSTRUAL SYNDROME
Distressing physical and psychological symptoms.
Factors: poor diet, stress, alcohol use, caffeine intake.
● Signs: (Occur during luteal phase)
○ Emotional - depression, anger,
irritability, fatigue.
○ Physical - painful and swollen breast,
bloating and abdominal pain, headache
and backache.
TX: tranquilizer, emotional support, symptomatic tx.
Nursing Mgt.: individualized data gathering and
appropriate intervention.
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REPRODUCTIVE DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

GYNECOLOGIC INFECTIONS: blood transfusion, correction of acid base balance

(metabolic).
ENDOMETRIOSIS
UTERINE LEIOMYOMAS
Abnormal location of endometrial tissue.
S/S: Abdominal and pelvic pain, low back pain,
TYPES: constipation, infertility, heavy and long menstruation.
● Internal
● External Risk Factors: High levels of estrogen and
progesterone - breastfeeding, pregnant, and
DX: laparoscopy perimenopausal individuals.

S/S: Pain, dyspareunia, painful bowel movement and TX: Uterine artery embolization, MR-Guided focused
urination, low backache during periods, difficulty in ultrasound surgery, surgical removal of tumor,
achieving pregnancy hysterectomy and medications.

TX: Treatment modalities fall into three categories:

pain relief, endometrial suppression, and surgery.
BREAST DISORDERS:
PELVIC IFLAMMATORY DISEASE
ACCESSORY NIPPLES / SUPERNUMERARY NIPPLES
Infection of the pelvic organs.
● Category one (known as polymastia) - extra
D/T: multiple sexual partners, use of IUD, STDs nipple will have an areola around, underlying
tissue is regular breast tissue
TX: analgesics, antibiotics, bed rest, avoidance of ● Category two - Extra nipple will not have an
intercourse areola around it, though the presence of breast
tissue underneath is still apparent.
TOXIC SHOCK SYNDROME
● Category three - Extra nipple is where the area
has breast tissue present, but no actual nipple
has formed.
Cause: staphylococcus aureus
● Category four - Extra nipple is where breast
tissue has formed underneath, but no nipple or
Factors: Use of tampons, contraceptives, surgical and
areola is present.
non surgical wounds, postpartum and gynecologic
● Category five (known as pseudomamma) -
infections
Extra nipple has an areola around the nipple
area, but instead of breast tissue underneath,
Manifestations: fever, vomiting, diarrhea, erythematous
fat tissue is found instead.
macular rash on palm and sole
● Category six (known as polythelia) - Extra
nipple is where the nipple appears alone and
Treatment: Antibiotics (penicillinase-resistant
penicillin), intravenous colloid, ventilation therapy,

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REPRODUCTIVE DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

there is no areola or breast tissue underneath VARIOUS TYPES OF HYMENS

it.

FIBROCYSTIC BREAST

Firbrocystic Breast Condition.

S/S: round fluid - filled cyst.

D/T: increase estrogen.

FIBROADENOMA

S/S: round, firmer, more rubbery, feels hard, painless

and free movable. REPRODUCTIVE DISORDERS IN MALE

BREAST CANCER PENILE DISORDERS:

BALANITIS (BALANOPOSTHITIS)

is inflammation of foreskin or prepuce of the penis. It

tends to occur in uncircumcised boys, is usually
caused by poor hygiene, or may accompany a
urethritis or a regional dermatitis (Morris, Waskett,
Banerjee, et al., 2012).

Balanitis - inflammation of the glans.

S/S: Pain during urination, swollen, red, and painful

glans (the head of the penis) and foreskin.

TX: heat application, antibiotic ointment, circumcision if

due to phimosis.

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REPRODUCTIVE DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

○ In severe cases, the opening of the

foreskin may be completely closed,
inhibiting urination and leading to
urinary tract obstruction.

PHIMOSIS
PARAPHIMOSIS
Foreskin or prepuce is constricted, tight and
unretractable. Entrapment of the glans by a phimotic foreskin, a band
of the foreskin behind the glans. Tight foreskin is
TYPES: retracted behind the glands.

● Physiologic phimosis - present until normal CAUSE: Rigorous cleaning, masturbation, catheter
adhesions between the foreskin and the glans insertion.
separate.
○ As normal secretions accumulate and TX: Gently pulling of foreskin and surgical incision of
there is sloughing of the skin, smegma foreskin.
accumulates.
○ This discharge maybe confused with
infectious penile discharge.

● Pathologic phimosis - occurs when the foreskin

cannot be retracted after puberty or when the
foreskin could previously beretracted.

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REPRODUCTIVE DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

SCROTUM DISORDERS:

CRYPTORCHIDISM

Cryptorchidism is failure of one or both testes to

descend from the abdominal cavity in to the scrotum
(Braga & Lorenzo, 2017).

CAUSE: fibrous band at inguinal canal, inadequate

length of spermatic cord, decrease testosterone level.

TYPES:

● True descended - inguinal ring

● Ectopic - still inside the abdomen

NURSING CARE: reassure of no castration, and

advice self testicular exam.
CHORDEE
TX: Orchiopexy and Chorionic gonadotrophin
Downward curvature of the penis. hormone.

CAUSE: fibrous tissue connecting the urethral

opening.

TX: Released at 6 - 12 months.

TESTICULAR TORSION

Twisting of the spermatic cord.

CAUSE: congenital anomaly, undescended testicle,

sexual activity, trauma, exercise, cold weather, active
cremasteric reflex.

DX: Doppler ultrasonography.

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REPRODUCTIVE DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

TX: Orchiopexy.

HYDROCELE
SPERMATOCELE
Painless collection of clear yellow fluids in scrotum.
Collection of milky fluid and dead spermatozoa.
DX: Transillumination.
TX: No Surgery
TX: Repair of hernia, aspiration and drainage.

HEMATOCELE VARICOCELE

Collection of blood. It is usually caused by scrotal
trauma and may be caused by a scrotal tumor.
Mass, similar to a hydrocele that does
transilluminate. Discolored scrotal skin.
Abnormal dilation of the veins of spermatic cords.
CAUSE: is incompetent or congenitally absent valves
not in spermatic veins.

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REPRODUCTIVE DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

TX: Scrotal support, surgery for severe pain. EPISPADIAS

A rare congenital malformation of the male or female

urogenital apparatus that consists of a defect of the
dorsal wall of the urethra.

● In males, opening is on top of the penis.

● In females, towards the clitoris or even below it.

URETHRA DISORDERS:

HYPOSPADIAS

An abnormality of anterior urethral and penile

development in which the urethral opening is
ectopically located on the ventral aspect of the
penisproximal to the tip of the glans penis, which, in
this condition, is splayed open.

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