Female Reproductive

System
Group 8: Myiesha Leslie, Jawaan Miranda, Lezli McCulloch, Brea McKay, Aleecah
Muslar, Ivymari Pat , Heldy Perez, Taiyana Wagner
 At the end of this presentation
t i v e s
Ob jec students will be able to:
1. Revise the anatomy and physiology of the
female reproductive system.
2. Outline the special considerations when
assessing the female reproductive system.
3. Discuss the healthy people document.
4. Discuss gathering data for the assessment of
the female reproductive system.
5. Explain how to conduct a physical assessment
of the female reproductive system.
6. Describe the abnormal findings of the female
reproductive system.
External Anatomy

Mons Pubis
-Mound of adipose tissue that lies over the pubic bone.

Labia Majora
-An extension of the skin surface, and is covered with coarse hair
extending from the mons pubis.

Labia Minora
-Two thin elongated pads of tissue that overlie the vaginal and
urethral openings and several glandular openings.
-The labia minora borders an almond shape known as the
vestibule which extends from the clitoris to the fourchette. The
urethral meatus, vaginal opening (introitus), Skene's and Bartholin
glands all lie within the vestibule.
External Anatomy
Glands
-Skene's Gland (Paraurethral Gland) is located posterior to the
urethra. It opens into the urethra and secrete fluid that lubricates
the vaginal vestibule during sexual intercourse.
-Bartholin's Gland or greater vestibular glands are located
posteriorly to the base of the vestibule. It produces mucus which is
released into the vestibule. This mucus actively promotes sperm
motility and viability.
Clitoris
The clitoris is a small, elongated mound of erectile tissue which is
located at the anterior vestibule. The clitoris serves as the primary
organ of sexual stimulation.

Perianal Area
Bordered anteriorly by the top of the labial folds and posteriorly by
the anus.
 Internal Female Reproductive Organs

Oviduct Ovary
(FALLOPIAN TUBE) Produces eggs (ova) and female
Passageway for eggs from the sex hormones like estrogen and
ovaries to the uterus and progesterone
provides the site for fertilisation
by the sperm

Uterus Vagina
Where a fertilised egg implants Receives the penis during
and grows into a fetus during sexual reproduction, allows the
pregnancy menstrual blood to exit the
Cervix body, and lets the baby passes
through during childbirth
Allows menstrual blood to flow from
the uterus and serves as a pathway
for sperm to enter the uterus
Menstruation Follicular Phase
Lining of the uterus is When the pituitary gland
shed, resulting in the releases hormones that stimulate
release of blood and 5 6 the growth and development of
4 7
tissue from the body 3 8 ovarian follicles
through the vagina 2 9

1 10

28
Stages of 11

27
the 12

26 Menstrual 13

25 Cycle 14

24 15

23 16
22 17
Luteal Phase 21
20 19
18 Ovulation Phase
Empty ovarian follicle becomes When a mature egg is
the corpus luteum, producing released from the ovary
hormones that prepare the uterus and is ready for potential
for possible embryo implantation fertilisation
 Special Considerations
Factors that influence the reproductive health of females include: age, developmental level, race,
ethnicity, work history, living conditions, socioeconomics, and emotional wellbeing.

During puberty, females

Factors that influence the
reproductive health of
females include: age,
developmental level, race,
ethnicity, work history, living
conditions, socioeconomics,
and emotional wellbeing.
At infancy, females have an
enlarged labia majora, visible
urinary meatus and vaginal
orifice, and “false menses”.
start menstruating and
developing breasts and
pubic hair.
It’s important to assess
female adolescents for
signs of physical and sexual
abuse in the vaginal,
perineal, and anal areas.
 Special Considerations
The cervix softens and has
increased vascularity which
may lead to a blue-purple
The uterus grows and
The uterus also undergoes discoloration. (Goodell's and
pushes up into the Chadwick's signs)
contractions throughout
abdominal cavity while
pregnancy, including
displacing organs like the There is also the formation
Braxton Hicks contractions.
liver. of a thick, protective
mucous plug at the
endocervical canal.
 Special Considerations
Internally, the female
reproductive organs
atrophy with age, vaginal
secretions decrease, and
sexual intercourse becomes
more painful.
Sexual drive can decrease
at any age due to fatigue,
depression, and stress.
Females might also avoid
As females age, their
sexual intimacy if they have
estrogen levels decrease
internal struggles with
and their menstrual periods
body image as a result of
occur less frequently until
their weight and body type,
eventually they experience
or as a result of
menopause.
reproductive surgeries.
 Special Considerations

Outside of the home,

females may be exposed to
harmful substances at
work like arsenic, lead and It is important for
Nurses are therefore females to adopt habits
expected to avoid radiation which have been
like washing the female
making assumptions linked to birth defects and
genitalia and
or passing judgment spontaneous abortions.
underclothes daily, while
on cultural practices, avoiding harmful
even female genital practices like douching
mutilation which is and engaging in
still practiced in unprotected sexual
Africa, Asia, and the intercourse.
Middle East.
Tanner Stages of female pubic hair development with
sexual maturation

Stage I: Preadolescent—no growth of pubic hair.

Stage II: Soft downy straight hair along the labia majora is an
indication that sexual maturation is beginning.

Stage Ill: Sparse, dark, visibly pigmented curly pubic hair on

labia.

Stage IV: Hair coarse and curly, abundant but less than adults.
Stage V:

Lateral spreading in triangle shape to medial surface of thighs.

 eop le
lthy P
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H ocume n t
D
 Gathering the Data
The subjective data:
Is gathered during the focused interview. The nurse uses various techniques to get general and specific
information
The objective data
Is the health records, laboratory test results and clinical examinations.

Focused Interview Includes:

Open ended and closed questions
Follow up questions

The nurse must:

Observe and listen for cues
Be sensitive to the patient’s need for privacy and carefully explain that all the information is confidential.

Consider:
The patient's ability to participate in the interview process and the physical assessment
Patients age, gender, race, culture, environment, health practices, past and concurrent health problems, and
therapies when framing questions.
 THE NURSE SHOULD ASK:
GENERAL QUESTIONS
Do you have any concerns about
your reproductive health? If so,
please tell me about those
concerns.
How old were you when you started
your first menstrual period?
How many days does your cycle
usually last? Is it consistent with
each period?
INFECTION/ ILLNESS SYMPTOMS.
Have you ever had an STD. Such
Have you noticed any rashes,
as herpes, gonorrhea, syphilis,
blisters, ulcers, sores, or warts on
HPV or chlamydia?
your genital or surrounding areas?
Have you ever had any surgery of
Have you had any vaginal bleeding
the reproductive system?
outside the time of
your normal menstrual period?
Have you ever had an abnormal
Pap smear?
 PAIN PRE SHOOL/ SCHOOL AGE CHILDREN
Has anyone ever touched you when you
Have you had any pain, tenderness, or
didn't want him/her to? Who? Where? How
soreness in your pelvic area?
many times? Is any one aware of this?

BEHAVIOR ADOLESCENTS
What kind of products do you use for hygiene
in the genital area? Are you having sex with anyone now?

How often do you get a physical examination? Have you been taught that sexual intercourse
Are you using contraceptives? What kind? can lead to STD’s and pregnancy?

INFANTS AND CHILDREN

Has the child complained of itching ,burning,
or swelling on the genital area?
 INTERNAL
PREGNANT WOMEN
ENVIRONMENT
Do you drink alcohol? How
many drinks per week?
Do you or the baby's father,
or anybody in your families, Do you use illicit drugs?
have any of the following
conditions:
Sickle cell anemia or trait OLDER ADULT EXTERNAL
Thalassemia
Down syndrome
When did menopause begin for you?
ENVIRONMENT
Cystic fibrosis Tell me about the physical changes Are you able to talk to your
Huntington's disease that’s been experienced after partner about your sexual
Muscular dystrophy menopause. needs?
Tay-Sachs
Hemophilia Any vaginal bleeding after menopause? Do your family and friends
any other blood or support your relationship
genetic disorders with your sexual partner?

Data gathered will relate to Have you ever been forced

the status of the urinary into sexual intercourse?
system.
 Physical Assessment
Instruct Patient:
Inform the patient that the procedure to be
performed entails the nurse touching the
external genitalia and looking to see the
cervix and the lining of the vagina.

Position Patient
Assist the patient into a lithotomy position,
which involves lying down on the bed with
her knees and hips bent and with the soles
of the feet in the stirrups.
 Inspect the External Genitalia

Inspection Inspect the pubic hair:

- Growth
- Texture of the hair
-Areas of growth

Inspect the labia majora.

-Integrity of the Skin
-Symmetry of the lips of the Labia
-Observe for deviances in the skin
-Observe for discharges
Prevent cross-contamination and maintain appropriate hygiene

Inspect the labia minora.

- Observe the labia minora for the color texture of the skin
- Observe for deviances in the skin

Inspect the clitoris.

- Separate the lips of the labia majora to visualize the clitoris,
which should be midline:
Observe the color of the clitoris
Observe for deviances in the skin
 Inspect the urethral orifice.
-Confirm the position of the orifice
-Observe the color
-Observe for deviances in the skin
-Ask the patient to cough. No urine should leak from the urethral opening.

Inspect the vaginal opening, perineum, and anal area.

-Confirm that the vaginal opening is pink and round It may
be either smooth or irregular.
-Observe for deviances in the skin

Observe the perineum

-The integrity of the skin
-Observe for deviances in the skin

Inspect the anus

- Ensure that the anus is intact
-The integrity of the Skin
- Color of the Skin
-Observe for deviances in the skin, protrusions, atrophy
 Instruct Patient

Palpation - Explain to the patient that you are going to palpate

the vaginal walls.
-Tell her that she will feel you insert a finger into the
vagina.

Palpate the vaginal walls:

- Place your left hand above the labia majora and
spread the labia minora apart with your thumb and
index finger.
- Position your right hand With your palm facing
toward the ceiling, gently place your right index
finger at the vaginal opening.
- Insert your right index finger gently into the vagina.
-Gently rotate the right index finger
counterclockwise.
-Note the texture of the vaginal wall, which should
feel rugate, consistent in texture, and soft.
- Ask the patient to bear down or cough. Note any
bulging in this area.
 Palpate the urethra and Skene's glands.
-Instruct patient
-Explain to the patient that you are going to palpate
her urethra. Inform the patient that pressure will be
felt against her vaginal wall.

- Your left hand should still be above the labia

majora, and you should still be spreading the labia
minora apart with your thumb and index finger.
-Your right index finger should still be inserted in
the patient's vagina. With your right index finger,
apply very gentle pressure upward against the
vaginal wall.
-Milk the Skene's glands by stroking them outward.
- Apply the same upward and outward pressure on
both sides of the urethra. No pain or discharge
should be elicited.
-Discharge from the urethra or Skene's glands may
indicate an infection such as gonorrhea.
 Palpate the Bartholin's glands.

With your right index finger still inserted in the

patient's vagina, gently squeeze the posterior region
of the labia majora between your right index finger
and right thumb.
Perform this maneuver bilaterally, palpating both
Bartholin's glands. No lump or hardness should be
felt.
No pain response should be elicited.
No discharge should be produced.
Speculum Examination
Instruct patient.
Tell the patient that you are going to examine her cervix and that to do so, you
are going to insert a speculum. Also, explain that she will feel pressure, first of
your fingers and then of the speculum.

Selecting the speculum should be the proper size for the patient.

Apply lubricating gel to the speculum, before insertion.

Insert the speculum.

Hold the speculum in your dominant hand. Place the index finger on top of the
blades, the third finger on the bottom of the blades, and be sure to move the
thumb just underneath the thumbscrew before inserting.

With your nondominant hand, place your index and middle fingers on the
posterior vaginal opening and apply pressure gently downward.

Turn the speculum blades obliquely. Place the blades over your fingers at the
vaginal opening and slowly insert the closed speculum at a 45-degree downward
angle.
This angle matches the downward slope of the vagina when the patient is
in the lithotomy position.

Ask the patient to bear down as you insert the speculum.

Once the speculum is inserted, withdraw your fingers and turn the
speculum clockwise until the blades are in a horizontal plane.

Advance the blades at a downward 45-degree angle until they are

completely inserted. This maneuver should not cause the patient pain.

Sweep the speculum blades upward until the cervix comes into view.

Adjust the speculum blades until the cervix is fully exposed between
them.

Tighten the thumbscrew to stabilize the spread of the blades.

Visualize the cervix.
 Confirm the position of the cervix
-Observe for discharge
-Observe for deviances to the cervix
-Confirm the viewing of the os

Remove the speculum.

- Gently loosen the thumbscrew on the speculum
while holding the handles securely.
-Slant the speculum from side to side as you slide it
from the vaginal canal.
-Close the speculum blades before complete
removal.
-While you withdraw the speculum, note that the
vaginal mucosa is pink, consistent in texture,
rugated, and non-tender.
-Discharge is thin or stringy and transparent or
opaque.
 Obtaining the Pap smear or Gonorrhea Culture

The Pap smear consists of three specimens: an endocervical swab,

cervical scrape, and a vaginal pool sample.

To perform an endocervical swab.

-Carefully insert a saline-moistened, cotton-tipped applicator into the
vagina and into the cervical os.
-Moistening the applicator with saline prevents the cells from being
absorbed into the
cotton.
- Do not force insertion of the applicator.
- Rotate the applicator in a complete circle
- Roll a thin coat across the slide that has been labeled endocervical.
- Spray fixative on the slide immediately or place it in a container filled
with a Fixative.
 Obtain a Cervical Scrape
Insert the longer end of a bifid spatula into the
patient's vagina.
Advance the fingerlike projection of the bifid end
gently into the cervical
os.
Allow the shorter end to rest on the outer ridge of
the cervix.
Rotate the applicator one full 360-degree turn
clockwise to scrape cells from the cervix.
Apply the specimen to the slide labeled that has
been labeled Vaginal. Spray fixative on the slide
immediately
 Obtain a gonorrhea culture.
- Obtain a gonorrhea culture if the
assessment findings indicate.
- Insert a saline-moistened cotton-tipped
applicator into the cervical os.
-Leave the applicator in place for 20
seconds to allow full cotton saturation.
-Using a Z-shaped pattern, roll a thin coat
of the secretions onto a thayer-Martin
culture plate labeled “cervical”.
Remove the speculum.
Stand at the end of the examination table. The patient remains in
the lithotomy position .

Palpate the cervix.

-Lubricate the index and middle fingers of your gloved dominant
hand.
-Place your nondominant hand against the patient's thigh, then
insert your lubricated index and middle fingers into her vaginal
opening.
-Proceed downward at a 45-degree angle until you reach the
cervix.
-Keep the other fingers of that hand rounded inward toward the
palm and put the thumb against the mons pubis away from the
clitoris.
Palpate the cervix.
-Gently try to move it. It should move easily about 1 to 2 cm (0.39
to 0.78 in.) in either direction.
 Palpate the fornices.
Slip your fingers into the vaginal recess areas,
called the fornices.
Palpate around the grooves.
Confirm that the mucosa of the vagina and cervix
in these areas is smooth and nontender.
Leave your fingers in the anterior fornix when you
have checked all sides.
Palpate the uterus.
Place the fingers of your nondominant hand on the
patient's abdomen.
Invaginate the abdomen midway between the umbilicus
and the symphysis pubis by pushing with your
fingertips downward toward the cervix.
Palpate the front wall of the uterus with the hand that is
inside the vagina.
As you palpate, note the position of the uterine body to
determine that the uterus is in a normal position. When
in a normal position, the uterus is tilted slightly upward
above the bladder, and the cervix is tilted slightly
forward.
Move the inner fingers to the posterior fornix, and
gently raise the cervix up toward your outer hand.
Palpate front and back walls of uterus as it sandwiches
between the two hands.
 Normal Variations oF
the UTERUS:
Anteversion uterus: tilted forward, cervix
tilted downward
Midposition uterus: lies parallel to tailbone,
cervix pointed straight
Retroversion uterus: tilted backward, cervix
tilted upward
Abnormal Variations oF
the UTERUS:
Anteflexion uterus: folded forward at about
a 90-degree angle, and cervix tilted
downward.
Retroflexion uterus: folded backward at
about a 90-degree angle, cervix tilted
upward
 Palpate the ovaries.
- While positioning the outer hand on the left lower
abdominal quadrant, slip the vaginal fingers into the
left lateral fornix.
Push the opposing fingers and hand toward one
another, and then use small circular motions to
palpate the left ovary with your intravaginal fingers.
Slide your vaginal fingers around to the right lateral
fornix and your outer hand to the lower right quadrant
to palpate the right ovary.
Confirm that the uterine tubes are not palpable.
Remove your hand from the vagina and put on new
gloves.
 Perform the rectovaginal
exam.
-Tell the patient that you are going to insert one
finger into her vagina and one finger into her
rectum in order to perform a rectovaginal exam.
-Lubricate the gloved index and middle fingers
of the dominant hand.
-Ask the patient to bear down.
-Touch the patient's thigh with your
nondominant hand to prepare her for the
insertion.
-Insert the index finger into the vagina (at a 45-
degree downward slope) and the middle finger
into the rectum.
-Compress the rectovaginal septum between
your index and middle fingers.
 Perform the rectovaginal
exam.
-Place your nondominant hand on the patient's
abdomen. While maintaining the position of your
intravaginal hand, press your outer hand inward
and downward on the abdomen over the
symphysis pubis.

-Palpate the posterior side of the uterus with

the pad of the rectal finger while continuing to
press down on the abdomen.
Confirm that the uterine wall is smooth and
nontender.
-If the ovaries are palpable, note that they are
normal in size and contour.
Remove your fingers from the vagina and rectum
slowly and gently.
Examine the stool
-Remove your gloves.
-Assist the patient into a comfortable position.
-Inspect feces remaining on the glove.

-Feces is normally brown and soft.

-Test feces for occult blood. Normally the test is
negative.

-Wash your hands.

-Give the patient tissues to wipe the perineal

area. Some patients may need a perineal pad.

-Inform the patient that she may have a small

amount of spotting for a few hours after the
speculum examination.
 Abnormal Findings

Dysmenorrhea Menopause Infertility

Primary dysmenorrhea is Permanent end of menstrual periods Not being able to conceive after
abnormal contractions of the The production of estrogen and one year of unprotected sex.
uterus due to a chemical progesterone decreases 1. untreated chlamydia or
imbalance in the body. “hot flashes”, vaginal atrophy, gonorrhea
relaxation of the pelvic muscle 2. anovulation
Secondary dysmenorrhea is 3. damaged or blocked fallopian
caused by endometriosis, PID, tubes
Vaginal Atrophy- Estrogen deficiency 4. endometriosis
uterine fibroids, abnormal
-thinning, drying and inflammation of 5. uterine fibroids
pregnancy (miscarriage,
the vaginal walls and pain with sex
ectopic), infection, tumors, or
polyps in the pelvic cavity.
 Abnormalities of the Uterus
Endometriosis
a disease in which tissue
similar to the lining of the
uterus grows outside the
uterus
severe pelvic pain,
endometrial scarring
commonly linked with
infertility
Uterine Fibroids Uterine Prolapse
The pelvic muscles and tissue weaken. This
common, non-cancerous
allows your uterus to drop down into your
muscle and tissue
vagina.
growths in the uterus
common causes include pregnancy,
abdominal pain, frequent childbirth, hormonal changes after
urination, excessive menopause, and straining on the toilet
menstrual bleeding,
uterine enlargement and urine leakage, heavy or pulling sensation in
constipation the pelvis, lower-back pain and vaginal
bleeding
 Abnormalities of the Cervix

Nabothian Cysts Chadwick’s SIgn Cervical Polyp Erosion or Ectropion

a non-specific, early sign of benign condition, where
benign cysts filled with benign growth,
pregnancy glandular cells that cover the
mucus on the surface usually protruding
bluish discoloration of the inner portion of your cervix
of the cervix or cervical from the surface of
cervix, vagina, and vulva are visible from the outside.
canal the cervical canal
It disappears shortly after is related to the hormone
birth. estrogen
may appear after bright red and may common in young women,
childbirth bleed. pregnant women and those
taking the oral combined
contraceptive pill.
Abnormalities of the
Fallopian Tube
Ectopic pregnancy
when a fertilized egg implants itself
outside of the womb

Salpingitis
inflammation of the fallopian tubes caused by
bacterial infection

pelvic pain, abnormal bleeding, vaginal discharge,

painful urination, fever, nausea and vomiting, or no
symptoms

common cause of female infertility because it can

damage the fallopian tube
Vaginitis : inflammation of the vagina

Trichomoniasis
STI
Thin, yellow-green, frothy
discharge

Bacterial vaginosis
Thin, off-white discharge
Fishy odor

Candida vaginitis
Thick, “cottage cheese”
discharge
 Sexually Transmitted Infections and Diseases

Gonorrhea “The Clap” Syphilis

Neisseria gonorrhoeae bacterium Treponema pallidum bacterium
Painful urination, watery and green-yellow Chancre (syphilitic sore) on vagina, anus,
discharge, vaginal bleeding rectum, lips or mouth
cured with antibiotics Treated with Benzathine penicillin G injection

Chlamydia
Chlamydia trachomatis bacterium
Painful urination, white-yellow discharge with a
foul odor, vaginal bleeding and itching
cured with antibiotics
 Human Papillomavirus
is the most common STI
generally no symptoms
treatment available for genital warts but no
cure for the virus
HPV vaccine

Herpes Simplex Virus

Type 1 (HSV-1) mostly spreads by oral
contact and causes oral herpes or cold
sores. Most adults are infected with HSV-1.
Type 2 (HSV-2) causes genital herpes.
Medicines can reduce symptoms but can’t
cure the infection
Cancers
Cervical Cancer Ovarian Cancer Vaginal Cancer
99% of cases are linked to abnormal cells in the ovary 90% are squamous cell
HPV infection. begin to grow and divide in carcinoma
an uncontrolled way
HPV vaccinations and observable small lumps
screening are effective, form a tumor (nodules) or ulcers
preventative measures
rectovaginal pelvic exam, a Colposcopy
Pap smear test transvaginal ultrasound, or
blood test
 ot.it
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Activity Link
HTTPS://CREATE.KAHOOT.IT/SHARE/FEMALE-REPRODUCTIVE-
SYSTEM/E0282DD6-1855-425B-9F6E-2B299D516CCE
 References
Cleveland Clinic. (2022, November 28). Female Reproductive System. Retrieved from
Cleveland Clinic website: https://my.clevelandclinic.org/health/articles/9118-female-
reproductive-system

D’Amico, D. T., & Barbarito, C. (2015). Health & Physical Assessment in Nursing. Pearson.

Gold, J. M., & Shrimanker, I. (2023). Physiology, Vaginal. Retrieved from PubMed website:
https://pubmed.ncbi.nlm.nih.gov/31424731/