Reproductive and Sexual Health

⮚ Concept of Unitive and Procreative Health

1. Unitive Health
Marriage is when a man and woman unite “as one flesh” Sex is unitive
Natural intercourse between a man and a woman
3. Procreative Health
Found only in natural intercourse
Sexual act is inherently ordered toward the creation of new
human life
Marriage needs to be open to the possibility of having children. Sex is procreative
✔ The unitive and procreative aspects of the sexual act are
inseparable.
4. Procreation: is the creation of a new human person, by the act of sexual
intercourse, by a man and a woman.
5. Creation: is the making of all things from nothing, by an act of God, at some
time in the past. God’s action could have taken a second, or 6 days, or a million
years
6. Evolutionary theory: is the theory that all things came about by the repeated
random actions of natural selection.
7. Sexual identity describes how a person identifies related to their sexual
orientation
8. Gender identity describes the gender with which a person identifies (i.e, whether
one perceives oneself to be a man, a woman, or describes oneself in some less
conventional way. Gender identity may be affected by a variety of social structures,
including the person's ethnic group, employment status, religion or irreligion, and
family.
9. Gender role a set of perceived behavioral norms associated particularly with
males or females, in a given social group or system
⮚ FEMALE/MALE REPRODUCTIVE SYSTEM
a. Female Reproductive syem
i. External Structures
1. Mons Veneris
⮚ Rounded, soft fatty tissue located over the symphysis pubis, the pubic bone joint.

⮚ It is covered by dark and curly pubic hair growth in typical triangular shape.

⮚ The purpose of the mons veneris is to protect the junction of the pubic bone from
trauma.
2. Labia Minora
⮚ just posterior to the mons veneris spreads two hairless folds of connective tissue.
⮚ Normally, the folds of labia minora are pink; the internal surface is covered with

mucous membrane, the external surface with skin. ⮚ The area is abundant with
sebaceous glands, so localized sebaceous cysts may occur here.
⮚ Protects the labia majora, urinary meatus and vaginal mucosa. 3. Labia
Majora
⮚ are two folds of adipose tissue covered by loose connective tissue and epithelium;
they are positioned lateral to the labia minora.
4. Clitoris
⮚ is a small (approximately 1 to 2 cm) rounded organ of erectile tissue at the forward
junction of the labia minora. it is covered by a fold of skin, prepuce.
⮚ The clitoris is sensitive to touch and temperature and is the center of sexual arousal
and orgasm in the female.
⮚ It is the structure that guides the nurse to the urinary meatus
5. Two Skene’s Gland (Paraurethral Glands)
⮚ are located just lateral to the urinary meatus, one on each side. The ducts open into
the urethra.
7. Bartholin’s Glands (vulvovaginal glands)
⮚ are located just lateral the vaginal opening on both sides.

⮚ It lubricates the external vulva during coitus

⮚ The secretion of alkaline ph helps to improve sperm survival in the vagina.

8. Fourchette
⮚ is the ridge of tissue formed by the posterior joining of the two labia majora.

⮚ Posterior to the fourchette is the perineal muscle or the perineal body.

9. Hymen
⮚ is a tough but elastic semicircle of tissue that covers the opening of the vagina in
childhood.

ii. Internal Structures

1. Vagina
⮚ Hollow membraneous canal, 3-4 inches long, located posterior to the bladder
and anterior to the rectum.
⮚ Acts as organ of copulation

⮚ Conveys sperm to the cervix

⮚ Expands to serve as birth canal

⮚ Wall contains many folds or rugae which permits stretching without tearing

⮚ Upper portion is separated from the rectum by the cul-de-sac of douglas.

✔ Passage between the cervical os and the external environment a. Passageway

for menstrual blood flow
b. Passageway for fetus
c. Passageway for penis for intercourse

Fornices – uterine end of the vagina; serve as a place for pooling of semen
following coitus

Bulbocavernosus – circular muscle act as a voluntary sphincter at the external

opening to the vagina (target of Kegal’s exercise)

2. Uterus
⮚ A muscular pear shaped organ located in the pelvis. It is 3 inches long, 2 inches
wide, 2 inches thick and weighing 50- 60 gms in a non-pregnant woman. Held in place
by broad ligaments.
⮚ cavity in which the fetus develops.

⮚ The cavity from which menstruation occurs.

Functions:
i. Receives ova from the fallopian tube
ii. Provides a place for implantation and nourishment during fetal growth
iii. Furnishes protection to a growing fetus
iv. Expels it from the body (when the fetus is already mature)

Divisions:
a. Corpus/ Body – main body part and forms the bulk of the uterus. It is the portion
of the uterus that expands so greatly to contain the growing fetus.
b. Fundus – the uppermost and widest part, portion of the uterus between the points
of attachment of the fallopian tube
c. Isthmus – a short segment between the corpus and the cervix. - forms the lower
uterine segment
d. Cervix – the lowest portion of the uterus.
Cervical Canal – cavity of the cervix
a. Internal Cervical Os – the junction of the canal at the isthmus b. External Cervical
Os – distal opening to the vagina.
3 Layers of Uterine Wall:
a. Endometrium – mucous membrane lining the uterus. (inner layer) b. Myometrium –
composed of muscle fibers. (middle layer) c. Perimetrium – composed of connective
tissue. (outer most layer) Uterine Ligaments
∙ Cardinal ligament – lower portion of the broad ligament. It is the main support of
the uterus.damage to this ligament will result to uterine prolapse.
∙ Broad ligament – supports the sides of the uterus & assists in holding the uterus in
anteversion.
∙ Round ligament – connects the uterus to the labia majora. Gives stability to the
uterus.
∙ Uterosacral ligament – connects uterus to the sacrum ∙ Anterior ligament
–provides support to the uterus in connection with the bladder. Overstretching of this
ligament will lead to herniation of the bladder to the vagina (cystocele). ∙ Posterior
ligament – forms the cul-de-sac of douglas. Damage to this ligament will lead to
herniation of rectum to the vagina ( rectocele).

2. Fallopian Tube
⮚ 2 trumpet shaped, thin, flexible, muscular tubes that are about 12 cm long. It has 2
openings: one into the uterine cavity and the other into the abdominal cavity.
Function:
a. Provide a place for fertilization of the ova by the sperm Parts:
a. Interstitial portion – lies nearest the uterine wall
b. Isthmus – portion of the tube that is cut or sealed in a tubal ligation or tubal
sterilization procedure.
c. Ampulla – it is the portion where fertilization of the ovum takes place; longest
portion of the tube.
d. Infundibulum – funnel-shaped and is covered by fimbriae that helps guide the
fertilized ova into the tube.
e. Fimbriae

Note:
a. isthmus – cut/sealed in Bilateral Tubal Ligation (BTL) b. ampulla – site of
fertilization
c. infundibulum – most distal segment; covered with fimbria

3. Ovaries
⮚ Almond shaped

⮚ Produce, mature and discharge ova

⮚ Initiate and regulate menstrual cycle

⮚ 4 cm long, 2 cm in diameter, 1.5 cm thick

⮚ Produce estrogen and progesterone

Estrogen:
i. promotes breast development & pubic hair distribution ii. prevents
osteoporosis
iii. keeps cholesterol levels
iv. reduced & limits effects of atherosclerosis
Layers of the Ovary
1. Tunica Albuginea - the outermost protective layer
surrounded by a single layer of cuboidal epithelium.
2. Cortex - the functional layer which is the site of ovum formation & maturation. It
contains the primordial
follicles, graafian follicles, corpus luteum & corpus
albicans.
3. Medulla - layer which contains the blood vessels,
lymphatics, nerves & muscle fibers.
4. Pelvis
⮚ the cavity that contains the generative organs and the canal (birth canal)
through which the fetus must pass during birth.
Pelvis is made up of 4 United Bones:
1. Two innominate bones or hipbones, divided into 3 parts: a) Ilium –
forms upper and lateral portion
b) Ischium- inferior portion
Ischial Spines – used to assess level to which the fetus has descended
c) Pubis – anterior portion
*Symphysis Pubis – junction of the innonimate bone at the front of the pelvis
2. Sacrum
a) Sacral Promontory – marked anterior projection formed by the junction of the last
lumbar vertebra with the sacrum
b) Sacroiliac Joint – located behind, between the sacrum and the ilia on either side.
3. Coccyx
a) Sacrococcygeal joint – between sacrum and coccyx which permits a degree of
movement
2 Division of the Pelvis:
∙ Linea Terminalis – drawn from the sacral prominence at the back to the superior
aspect of the symphysis pubis at the front of the pelvis.
a. False Pelvis
✔ superior half formed by the ilia

✔ Functions:
o Offers landmarks for pelvic measurement
o Supports the growing uterus during pregnancy
o Directs the fetus into the true pelvis near the end of
gestation

b. True Pelvis
✔ inferior half formed by the pubis in front, the ilia and the ischia
on the sides and the sacrum and coccyx behind
3 Parts of True Pelvis
1. Pelvic Inlet/ Brim
- entrance to the true pelvis
- wider transversely
2. Pelvic Cavity
- space between the inlet and the outlet.
- level of the ischial spine marks the midpoint or midplane of
the pelvis
3. Pelvic Outlet
- inferior portion of the true pelvis
- Anteroposterior diameter is greater than the transverse
3 Types of Pelvis
1. Gynecoid
✔ “normal female pelvis”

✔ Inlet is well rounded forward and backMost ideal for

child birth
3. Anthropoid
✔ “Ape like pelvis”

✔ Transverse diameter is narrow; AP diameter of the inlet

is larger than normal
4. Platypelloid
✔ “Flattened pelvis”

✔ Inlet is oval, smoothly curved but the A-P diameter is

shallow.
✔ Fetal head could not rotate to match the curve of the
pelvic cavity.
5. Android
✔ “Male pelvis”

✔ Pubic arc forms an acute angle. Making the lowest

dimensions’ extremely narrow
✔ Fetus has difficulty exiting from the pelvis.
D. PELVIC MEASUREMENTS AND PELVIMETRY
✔ Performed with radiography and or internal examination

✔ Indication: to determine whether or not the pelvis is large enough to allow the fetus
to pass through
A. External Pelvic Measurement
- suggestive only of pelvic siz
Types:
1. Intercristal
- distance between middle point s of iliac crest (28 cms)

2. Interspinous
- distance between the anterosuperior iliac spine ( 25 cms)

3. Intertrochanteric
- distance between the trochanters of the femur ( 31 cms)

4. External conjugate/Baudelocque’s
- distance between the anterior aspect of the symphysis pubis and depression below
the L5 (18-20 cms)

B. Internal Pelvic Measurement

- To determine the actual diameters of the inlet and outlet through which the fetus
must pass.

- Types:

1. Diagonal Conjugate

– the distance between anterior surface of the sacral prominence and the anterior
surface of the inferior margin of the symphysis pubis.

- most useful measurement for estimation of pelvic size because it suggests the AP
diameter of the pelvic inlet

- Average margin: 12.5 – 13 cm

- How is it measured:
a. Place woman in a lithotomy position
b. Two fingers are introduced vaginally and pressed inward and upward until the
middle finger touches the sacral promontory.
c. Mark the examining hand where it touches the symphysis pubis. d. Withdraw the
examining finger, and the distance between the tip of the middle finger and the
marked point on the examining hand is measued by a pelvimeter.
2. True Conjugate (Conjugate vera)
– distance between the anterior surface of the sacral prominence and the posterior
surface of the inferior margin of the symphysis pubis.

- cannot be measured directly but can be estimated from the measurement of the
diagonal conjugate (the depth of s. pubis is assumed to be 1.5-2 cms)

- Average margin: 10.5 – 11 cm

3. Ischial Tuberosity Diameter

– distance between the ischial tuberosities or the transverse diameter of the outlet.

- Average margin: 11 cms