MODULE: HEALTHASSESSMENT AND CLARKSHIP (1208)

GROUP COURSE WORK / PRESENTATION

TOPIC: FEMALE REPRODUCTIVE SYSTEM
GROUP 3 MEMBERS:
NAMES REGISTRATION NUMBERS
Kabugho Rosette VU-BMS-2307-0010-WEE
Nambirige Maureen VU-BMS-2307-1053-WEE
Mvako Topister VU-BMS-2307-0820-WEE
Oluru Josephine VU-BMS-2307-0347-WEE
Candiru Eunice VU-BMS-2307-0798-WEE

LECTURER: CLIFTON IRAHUKA

 Presentation outline:
 Anatomy and physiology
 Stages of development
 Videos
 Changes in pregnancy
 Complications
 Possible abnormal things and
 management
 Anatomy and physiology:
Introduction
 The female reproductive system is a complex system responsible for the
production of eggs, the development of embryos, and the nurturing of offspring.
It consists of both external and internal structures, and its main functions include
the production of eggs (ova), fertilization, implantation, and supporting the
development of a fetus during pregnancy. Here's an overview of the key
components of the female reproductive system:
THE EXTERNAL GENITALIA/ VULVA
 The structure continues:
The external genitalia are called the vulva.
 The mons pubis: Is a round, firm pad of adipose tissue covering the symphysis pubis.
After puberty it is covered with hair in the pattern of an inverted triangle.
 The labia majora: Are two rounded folds of adipose tissue extending from the mons pubis
down and around to the perineum.
After puberty hair covers the outer surfaces of the labia, whereas the inner folds are smooth
and moist and contain sebaceous follicles.
 The labia minora: Are two smaller, darker folds of skin found inside the Labia majora,
these are joined anteriorly at the clitoris where they form a hood, or prepuce, posteriorly by
a transverse fold, the frenulum, or fourchette.
 Structure cont.
 The clitoris: Is a small, pea-shaped erectile body, homologous with the male
penis and highly sensitive to tactile stimulation.
The labial structures encircle a boat-shaped space, or cleft, termed the vestibule and
within it are numerous openings.
 The urethral meatus: This appears as a dimple 2.5 cms posterior to the clitoris.
and Surrounded by the tiny, multiple Para urethral (Skene) glands. Their ducts
are not visible but open posterior to the urethra at the 5 and 7 o'clock positions.
 Vaginal orifice: The vaginal orifice is posterior to the urethral meatus. It appears
either as a thin median slit or a large opening with irregular edges, depending on
the presentation of the membranous hymen
 Structure cont.

 The hymen
is a thin layer of mucous membrane that stretches across the vaginal lumen,
just inside the external opening. It is normally incomplete to allow for passage
of menstrual flow, and is stretched or completely torn away by sexual
intercourse, insertion of a tampon or childbirth.
 Vestibular (Bartholin) glands
Located on either side and posterior to the vaginal orifice, and secrete a clear
lubricating mucus during intercourse. Their ducts are not visible but open in the
groove between the labia minora and the hymen.
The female internal genitalia
 INTERNAL GENITALIA:
Vagina
The vagina is a fibromuscular tube lined with stratified squamous epithelium
opening into the vestibule at its distal end and with the uterine cervix protruding
into its proximal end.
 It runs obliquely upwards and backwards at an angle of about 45 degrees
between the bladder in front and the rectum and anus behind. In the adult, the
anterior wall is about 7.5 cm long and the posterior wall about 9 cm long.
 The difference is due to the angle of insertion of the cervix through the anterior
wall.
 Internal genitalia Cont…
Structure of the vagina
 The vaginal wall has three layers: an outer covering of areolar tissue, a middle layer of
smooth muscle and an inner lining of stratified squamous epithelium that forms ridges
or rugae.
 It has no secretory glands but the surface is kept moist by cervical secretions.
 Between puberty and the menopause, Lactobacillus acidophilus, a bacterium that
secretes lactic acid is normally present, maintaining the pH of cervical canal between
4.9 and 3.5.
 The acidity inhibits the growth of most other microorganisms that may contaminate
the vagina from the perineum or during sexual intercourse.
 Internal genitalia Cont…
Uterus:
 The Uterus is a pear-shaped, thick-walled, muscular organ. It is flattened
anteroposteriorly, measuring 5.5 to 8 cm long by 3.5 to 4 cm wide and 2 to 2.5
cm thick.
 It is freely movable, not fixed, and usually tilts forward and superior to the
bladder (a position labeled as ant everted and ante flexed
 And it weighs between 30 and 40 grams. It has 3 main parts:
Fundus
 This is the dome-shaped part of the uterus above cervix and openings of the
uterine tubes.
 Uterus Cont…
Body
 This occupies the upper two-thirds of the uterus. It is pear-shaped, and
narrowest inferiorly at the internal os, where it is continuous with the cervix.
 This is the narrowest portion and is usually about 25 cm long. It protrudes
through the anterior wall of the vagina opening into it at the external os.
Cervix (neck of the uterus)
 This is the narrowest portion and is usually about 25 cm long. It protrudes
through the anterior wall of the vagina opening into it at the external os.
 Uterus Cont…
Structure of the uterus
The walls of the uterus are composed of three layers of tissue: perimetrium,
myometrium and endometrium.

Perimetrium
 The perimetrium can be imagined as a blanket draped over the uterus, uterine
tubes and ovaries from above, so it mainly covers the anterior, upper and
posterior surfaces of the uterus. Anteriorly, it lies over the fundus and the
body, where it is folded on to the upper surface of the urinary bladder. This
fold of peritoneum forms the vesicouterine pouch.
 Uterus Cont…
Structure of the Uterus
 Posteriorly, the peritoneum covers the fundus, the body and the cervix, then it
folds back on to the rectum to form the rectouterine pouch (of Douglas).
 Laterally, only the fundus is covered because the peritoneum forms a double
fold with the uterine tubes in the upper free border. This double fold is the
broad Ligament which at its lateral ends, attaches the uterus to the sides of the
cervix.
Myometrium
This is the thickest layer of tissue in the uterine wall. It is a mass of smooth
muscle fibers interlaced with areolar tissue, blood vessels and nerves.
 Uterus Cont…
Structure of the Uterus
Endometrium
 This is columnar epithelium covering a layer of connective tissue containing
abundant mucus secreting tubular glands. It is richly supplied with blood by
spiral arteries, branches of the uterine artery. It is divided into two layers:
 The functional layer is the upper layer and it thickens and becomes rich in
blood vessels in the first half of the menstrual cycle when the ovum is not
fertilized and does not implant, this layer is shed during menstruation
 Structure of the Uterus cont’

The basal layer

 lies next to the myometrium and is not lost during menstruation.
 It is the permanent layer, from which the fresh functional layer is regenerated
during each cycle.
 The upper two—thirds of the cervical canal is lined with
a mucous membrane. Lower parts contain the stratified squamous epithelium
that merges with the lining of the vagina itself
 Internal genitalia Cont…

Uterine / Fallopian Tubes:

 The uterine (Fallopian) tubes are about 10 cm long and extend from the sides
of the uterus between the body and the fundus.
 They lie in the upper free border of the broad ligament and their trumpet-
shaped lateral ends penetrate the posterior wall, opening into the peritoneal
cavity close to the ovaries.
 The end of each tube has finger-like projections called fimbriae. The longest of
these is the ovarian fimbriae which is in close association with the ovary.
 Structure of the uterine tubes:
The uterine tubes are covered with peritoneum (broad ligament), have a middle
layer of smooth muscle and are lined with ciliated epithelium. Blood and nerve
supply and lymphatic drainage are as for the uterus.
Ovaries:
 The ovaries are the female gonads and they lie in a shallow fossa on the
lateral walls of the pelvis. They are 25-3.5 cm long, 2 cm wide and 1 cm
thick.
 Each is attached to the upper part of the uterus by the ovarian ligament and to
the back of the broad ligament by a broad band of tissue, the mesovarium.
Blood vessels and nerves pass to the ovary
through the mesovarium.
 Internal genitalia Cont…
Structure of the Ovaries
The ovaries have two layers of tissue the medulla and cortex.
 Medulla
This lies in the center and consists of fibrous tissue, blood vessels and nerves
 Cortex
This surrounds the medulla. It has a framework of connective
tissue (stroma) covered by germinal epithelium. It contains ovarian follicles in
various stages of maturity, each of which contains an ovum.
 Structure of ovaries cont’
 Before puberty the ovaries are inactive but the stroma already contains
immature (primordial) follicles, which the female has from birth.
 During the childbearing years, about every 28 days, one or more ovarian
follicle matures, ruptures and releases its ovum.

 This is called ovulation and it occurs during the menstrual cycle. Following
ovulation the ruptured follicle develops into the corpus luteum (yellow body),
which in turn will leave a small permanent scar of fibrous tissue called the
corpus albicans (white body) on the surface of the ovary.
Oogenesis/ Ovulation/ Ovarian Cycle
 Physiology of the female reproductive
system:
 The female reproductive system is a network of organs and structures that work
together to facilitate reproduction.
 Its primary functions include producing eggs (ova), providing a suitable
environment for fertilization and development of the embryo, and supporting the
growth and nourishment of the fetus during pregnancy. Different organs have
different functions as stated below;
Ovaries:
Paired organs located on either side of the uterus.
It Produce eggs (ova) and female sex hormones (estrogen and progesterone).
 Physiology cont’

Fallopian tubes:
Tubes that extend from each ovary to the uterus.
Provide a pathway for eggs to travel from the ovaries to the uterus; it is also the
site where fertilization typically occurs.
Uterus:
Muscular organ situated in the pelvic cavity.
Nurtures and houses a fertilized egg during pregnancy. The lining of the uterus
(endometrium) thickens in preparation for implantation.
 Physiology cont’
Cervix:
Located in the Lower portion of the uterus that connects to the vagina and acts as a
passageway between the uterus and vagina; also produces mucus that changes in
consistency during the menstrual cycle.
The vagina
serves as a passageway for menstrual flow, receives the penis during sexual
intercourse, and acts as the birth canal during childbirth.
Labia Majora and Labia Minora:
External folds of skin surrounding the vaginal opening.
Protect and enclose the external genitalia.
 Physiology cont.
Clitoris: Is small, sensitive organ located at the anterior junction of the labia minora.
It Contains a high concentration of nerve endings and is involved in sexual arousal.
Skene’s Glands and Bartholin’s Glands: Skene's glands are near the urethra, and Bartholin's
glands are near the vaginal opening.
They Secrete fluids that contribute to lubrication during sexual activity.
Mammary glands (Breasts):
Paired structures on the chest.
It Produces milk to nourish the newborn after childbirth.
 Physiology contn’
 The external genitalia protect the internal reproductive organs and are
involved in sexual arousal and intercourse.
 The menstrual cycle regulates the release of eggs, prepares the uterus for
potential pregnancy, and ensures the proper functioning of the reproductive
system.
 These hormones play key roles in regulating the menstrual cycle, supporting
the development of secondary sexual characteristics, and maintaining
pregnancy.

 Assessment of the female reproductive system
Subjective data
 1.Menstrual history
 2. Obstetric history
 3. Menopause
 4. Patient-centered care
 5. Acute pelvic pain
 6. Vaginal discharge
 7. Sexual activity
 8. Contraceptive use
 9. Sexually transmitted infection (STI) contact
 Assessment Ctd…
Menstrual history.
• Date of your last menstrual period? LMP—Last menstrual period.
• Age at first period? Menarche
• How often are your periods?
 Amenorrhea—Absent menses.
• How many days does your period last?
• Usual amount of flow: light, medium, heavy? How many pads or
tampons do you use each day or hour?
• Any clotting? Clotting indicates heavy flow or vaginal pooling.
• Any pain or cramps before or during period? How do you treat it?
 Assessment Ctd…
Obstetric history
. Have you ever been pregnant?
• How many times? Gravida—Number of pregnancies.
• How many babies have you had? Para—Number of births.
• Any miscarriage or abortion?
• For each pregnancy describe: duration, any complication, labor and
delivery, baby's sex, birth weight, condition.
• Do you think you may be pregnant now? What symptoms have you noticed?
 Assessment Ctd…
Menopause
. Have your periods slowed down or stopped? Menopause, cessation of
menstruation.
• Any associated symptoms of menopause (e.g., hot flashes, night sweats,
numbness and tingling, headache, palpitations, drenching sweats, mood swings,
vaginal dryness, itching)?
 Any treatment?
 Perimenopausal period from ages 40 to 55 years has hormone
 shifts, resulting in vasomotor instability.
 Assessment Ctd…
• If hormone replacement therapy (HRT), how much? How is it working?
 Any side effects?
 Side effects of HRT include fluid retention, breast pain, vaginal
 bleeding, and cardiovascular and breast cancer risk.
• How do you feel about going through menopause? Although a normal life stage,
reaction varies from acceptance to
 Assessment Ctd…
Patient-centered care.
How often do you have a gynecologic checkup?
 The recommended screening for cervical cancer prevention by age:
 No Pap tests if you are under 21 years, regardless of sexual activity
 Pap test once every 3 years for women ages 21-30 years;
 HPV and Pap “co-testing” every 3 years for women ages 30-65 years.
 When was our last Pap test? Results?
 Although Pap tests save lives, adolescents and young women have high rates
of HPV infection than their own immune systems can clear.
 Assessment Ctd…
 Delaying Pap testing until age 21 allows the HPV infections to regress
spontaneously in adolescents, avoiding overtreatment.
 We do recommend yearly screening for chlamydial infection in all sexually active
women under 25 years and in older women with a new sex partner, more than one
sex partner, or a sex partner with other partners.
 We do this by testing first-catch urine.
 Assessment Ctd…
Acute pelvic pain.
Any pain in the lower abdomen or pelvis?
When did it start? Constant or come and go? Associated with periods? On a scale
of 1 to 10, with 10 being the strongest, how would you rate your pain?
 Acute pain lasts <3 months. Consider urgent conditions:
pelvic inflammatory disease (PID), appendicitis, ruptured ovarian cysts,
ovarian torsion, which need transvaginal ultrasound imaging.
 Assessment Ctd…
Vaginal discharge
 . Any unusual vaginal discharge? Increased amount?
 Normal discharge is small, clear or cloudy, and always nonirritating.
 Character or color: white, yellow-green, gray, curdlike, foul smelling?
Suggests vaginal infection; character of discharge often suggests causative
organism.
 When did it begin? Acute versus chronic problem.
 Vaginal discharge Ctd…
 Is the discharge associated with vaginal itching, rash, pain with intercourse?
 Rash is result of irritation from discharge. Dyspareunia occurs with vaginitis
of any cause.
 Taking any medications? Oral contraceptives increase glycogen content of
vaginal epithelium, providing fertile medium for some organisms.
 Broad-spectrum antibiotics alter balance of normal flora.
 Family history of diabetes? Diabetes increases glycogen content.
 In which part of your menstrual cycle are you now? Menses, postpartum,
menopause have a more alkaline vaginal.
 Assessment Ctd…
PH of the Vagina.
 Use a vaginal douche? How often? Frequent douching alters pH.
 Use feminine hygiene spray? Spray has risk for contact dermatitis.
 Wear non-ventilating underpants, pantyhose?
 Treated the discharge with anything? Result?
 Local irritation
Past history
 Any other problems in the genital area? Sores or lesions now or in the past?
How were they treated? Any abdominal pain?
 Any past surgery on uterus, ovaries, vagina? Assess feelings. Some fear loss of
sexual response after hysterectomy, which may affect intimate relationships.
 Assessment Ctd…
Sexual activity
Often women have a question about their sexual relationship and how it
affects their health.
 Are you in a relationship involving sex now?
 How are aspects of sex satisfactory to you and your partner?
 Are you Satisfied with the way you and partner communicate about sex?
 Do you have more than one sexual partner?
 Begin with open-ended question to assess individual needs.
 Include appropriate questions as a routine. Communicates that you accept
individual's sexual activity and believe that it is important.
 Have you and partner discussed having children?
 Assessment Ctd…
STI contact
Any sexual contact with partner having an STI such as gonorrhea, herpes,
HIV/AIDS, chlamydial infection, venereal warts, syphilis? When? How was it
treated? Were there any complications?
 A STI can be transmitted during vaginal, oral, and anal sexual contact with an
infected partner. Treating patient and the sex partner(s) prevents reinfection
and infection of others.
 Any precautions to reduce risk for STIs? Use condoms at each episode of
sexual intercourse?
 Assessment Ctd…
Objective Data
 Preparation of equipments and Assembling of instruments for examinations like
speculum. Here we can either do inspection or palpation.
On inspection,
We view the following;
• The Clitoris.
• Urethral opening appears stellate or slitlike and is midline.
• Vaginal opening or introitus, may appear as a narrow vertical slit or as a larger
opening.
• Perineum, a well-healed episiotomy scar, midline or mediolateral, may be present after
a vaginal birth.
• Anus has coarse skin of increased pigmentation
 Objective Data Ctd…
On Palpation
 Assess Bartholin glands. Palpate the posterior parts of the labia majora with
your gloved index finger in the vagina and your thumb outside at 5 and 7
o'clock positions for swellings.

Internal Genitalia
 Speculum Examination is done.
Select the proper-size speculum.
Further, use lubricant to decrease pain, and may increase compliance in older
women with vaginal atrophy.
 Objective Data Ctd…
The cervix
 Inspect the Cervix and Its Os
Note:
 Color. Normally the cervical mucosa is pink and even.
During the 2nd month of pregnancy it looks blue (Chadwick sign), and after
menopause it is pale.
 Position. Midline, either anterior or posterior. Projects 1 to 3 cm into the
vagina.
 Size. Diameter is 2.5 cm (1 inch).
 Os. This is small and round in the nulliparous woman. In the parous woman it
is a horizontal, irregular slit and also may show healed lacerations
 Objective Data Ctd…
 Surface: This is normally smooth, but cervical eversion, or ectropion, may
occur normally after vaginal deliveries.
 The endocervical canal is everted or “rolled out.” It looks like a red, beefy
halo inside the pink cervix surrounding the os.
 Note the cervical secretions. Depending on the day of the menstrual cycle,
secretions may be clear and thin, or thick, opaque, and stringy.
Obtain Cervical specimens for Tests and Cultures
 The Pap test screens for cervical cancer
 infectious discharge if present by picking a high vaginal swab.
 Assessment Ctd…
Developmental competence
Infants and Children
 Infant—Place on examination table.
 Toddler/preschooler—Place on parent's lap.
 Frog-leg position—Hips flexed, soles of feet together and up to bottom.
 Preschool child may want to separate her own labia.
 No drapes—The young girl wants to see what you are doing.
 School-age child—Place on examination table, frog-leg position, no drapes.
 During childhood a routine screening is limited to inspection of the external
genitalia to determine that the structures are
 The newborn's genitalia are somewhat engorged.
 The labia majora are swollen, the labia minora are prominent and protrude beyond the
labia majora, the clitoris looks relatively large, and the hymen appears thick. Because of
transient engorgement, the vaginal opening is more difficult to see.
 STAGES OF DEVELOPMENT OF FEMALE REPRODUCTIVE
SYSTEM

 The female reproductive system derives from four origins: mesoderm, primordial
germ cells, coelomic epithelium, and mesenchyme.
 The uterus forms during Mullerian organogenesis accompanied by the development of
the upper third of the vagina, the cervix, and both fallopian tubes.
 The development of the female reproductive system begins before birth and continues
through puberty. Here are the key stages of development:
Gonadal Development (Weeks 4-6): Initially, the gonads are undifferentiated in the
early embryo. Around the sixth week of gestation, if the fetus carries two X
chromosomes (XX), the gonads develop into ovaries.
If the fetus has a Y chromosome (XY), the gonads develop into testes.
The expression of specific genes guides the undifferentiated gonads toward forming
ovarian tissue.
 Stages cont.
Differentiation of Mullerian Ducts (Weeks 6-10)
 Mullerian ducts, also known as paramesonephric ducts, are bilateral structures that
form parallel to the Wolffian ducts (which develop into male reproductive structures).
 In the absence of anti-Mullerian hormone (AMH) from the testes, the Mullerian ducts
persist and develop into the female reproductive organs.

Paramesonephric Duct Fusion:

 Fusion of the paramesonephric ducts results in the formation of a single uterus. If
fusion is incomplete, it can lead to variations in uterine structure, such as a septate or
Bicornuate uterus.
 Stages cont.

 Formation of External Genitalia:

The differentiation of external genitalia involves the influence of hormones, particularly
androgens and estrogens.
The labia majora and minora, as well as the clitoris, form during this process.
VIDEO LINK: https://www.youtube.com/watch?v=gmK1XYVm8xM
 Ovary Development:
Initially positioned near the kidneys, the ovaries gradually descend into the pelvic cavity.
Ligaments, such as the ovarian ligament and suspensory ligament, anchor the ovaries in
their final position.
 Stages cont.
 Embryonic Stage: Weeks 1-5: The gonadal ridges develop on either side of the
urogenital ridge. In females, these gonadal ridges develop into the ovaries.
 Fetal Stage: Weeks 6-22: The primordial germ cells migrate to the developing
ovaries, where they differentiate into oogonia (precursors to eggs). The ovarian
follicles, which contain the eggs, begin to form.
 Neonatal Period: Birth to Puberty: At birth, a female typically has all the eggs she
will ever have. However, these eggs are in an immature state (oocytes) and do not
complete development until later in life.
 Stages cont.
 Childhood:
Pre-puberty: The reproductive system remains relatively inactive during childhood.
The ovaries are present, but the reproductive organs are not fully developed.
Maturation and Readiness for Puberty.
 Around Ages 8-14: Puberty marks the onset of reproductive maturity. The
hypothalamus signals the pituitary gland to release hormones that stimulate the
ovaries.
 This leads to the development of secondary sexual characteristics, such as breast
development and the growth of pubic hair. Menstruation typically begins a couple
of years into puberty.
 Stages cont.
 Menstrual Cycle:
Menstruation is a monthly process where the lining of the uterus thickens in
preparation for a potential pregnancy. If fertilization does not occur, the lining is
shed during menstruation.
 Reproductive Years:
Late Teens to Late 40s/Early 50s: Women are fertile and capable of conceiving
during this period. Ovulation occurs regularly, usually on a monthly basis.
 Perimenopause:
Late 30s/Early 40s to Menopause: This transitional stage precedes menopause
and involves hormonal fluctuations, leading to changes in menstrual patterns and
the gradual decline of fertility.
 Stages cont.

Menopause:
 Late 40s to Early 50s: Menopause is the cessation of menstruation, marking the
end of a woman's reproductive years.
 It is defined as the absence of menstrual periods for 12 consecutive months.
Hormonal changes during menopause lead to various physical and emotional
symptoms.
 It's important to note that these stages can vary among individuals, and the ages
mentioned are generalizations.
 The development of the female reproductive system is influenced by genetic,
environmental, and nutritional factors. Additionally, each woman may experience
puberty and menopause at different ages.
 Changes that occur during pregnancy
Throughout pregnancy, the female reproductive system undergoes significant
changes to support the development and well-being of the growing fetus. Some key
changes include
Uterine expansion
The uterus, a muscular organ, grows in size to accommodate the developing fetus.
This process is essential for providing sufficient space for the baby to grow and
mature.
As the uterus expands, it puts pressure on surrounding organs and tissues, which can
contribute to discomfort and changes in posture.
 Changes cont.

 Vaginal Changes.
Hormonal influences, particularly estrogen, lead to increased blood flow and
changes in the vaginal walls. This increased vascularity contributes to the
characteristic bluish tint of the vaginal mucosa during pregnancy. These changes,
along with increased elasticity, help prepare the birth canal for the passage of the
baby during delivery.

 Ovarian changes.
Ovulation typically ceases during pregnancy due to the elevated levels of hormones
such as hCG and progesterone. This halting of the menstrual cycle is a natural part
of maintaining the pregnancy and preventing the release of additional eggs.
 Changes cont.

 Ovarian changes.
Ovulation typically ceases during pregnancy due to the elevated levels of
hormones such as hCG and progesterone.
This halting of the menstrual cycle is a natural part of maintaining the pregnancy
and preventing the release of additional eggs.
 Breast Changes.
Hormonal changes, particularly the increase in estrogen and progesterone,
stimulate the growth of mammary glands and result in breast enlargement. The
breasts become more sensitive, and the areolas (the darker area around the
nipples) may darken.
 Changes cont.
These changes prepare the breasts for lactation, the production of breast milk to
nourish the newborn. These intricate and interconnected changes are essential for
a successful pregnancy and the healthy development of the baby.
 Changes cont.
 Cervical Changes.
As pregnancy progresses, the cervix undergoes a series of changes in preparation
for childbirth.
These changes include softening of the cervix (known as effacement), dilation
(opening of the cervix), and changes in position.
These adaptations facilitate the passage of the baby through the birth canal during
labor.
 Placental Development
The placenta is a temporary organ that forms during early pregnancy. It attaches
to the uterine wall and serves as a crucial interface between the mother and the
developing baby.
 Changes cont.
The placenta allows for the exchange of nutrients, oxygen, and waste products between
the maternal and fetal bloodstreams, providing the necessary support for fetal growth.
 Blood Flow. The cardiovascular system undergoes changes to meet the increased
demands of pregnancy.
Hormones, such as relaxin, contribute to the dilation of blood vessels, ensuring an
adequate supply of nutrients and oxygen to the developing fetus.
The increased blood flow can also lead to changes in blood pressure.
 Metabolic Changes: Increased Metabolism: The body's metabolic rate increases to
provide energy for fetal development.
 Complications:

The reproductive system is complex, and various complications can occur,

affecting both male and female reproductive organs. Here are some common
complications:
In Females:
Menstrual Disorders:
 Dysmenorrhea: Painful menstruation.
 Menorrhagia: Heavy or prolonged menstrual periods.
 Amenorrhea: Absence of menstruation.
 Complications cont.
Certainly, here are some complications that can affect the female reproductive system:
 Polycystic Ovary Syndrome (PCOS): PCOS is a common hormonal disorder among
women of reproductive age. It can cause irregular menstrual cycles, cysts on the ovaries,
and hormonal imbalances, leading to fertility issues.
 Endometriosis: Endometriosis occurs when the tissue lining the uterus (endometrium)
grows outside the uterus. This can lead to pelvic pain, painful menstruation, and fertility
problems.
 Uterine Fibroids: Uterine fibroids are noncancerous growths in the uterus that can cause
heavy menstrual bleeding, pelvic pain, and pressure on the bladder or rectum.
 Complications cont…
 Pelvic Inflammatory Disease (PID): PID is an infection of the reproductive organs,
often caused by sexually transmitted bacteria. It can lead to inflammation, scarring,
and damage to the fallopian tubes, increasing the risk of infertility.
 Ovarian Cysts: Ovarian cysts are fluid-filled sacs that can form on the ovaries. While
many are harmless and resolve on their own, some may cause pain, rupture, or interfere
with fertility.
 Complications cont…
 Amenorrhea: The absence of menstruation. It can be caused by factors such as
hormonal imbalances, stress, excessive exercise, or certain medical conditions.
 Dysmenorrhea: Refers to painful menstruation. It can be primary (common
menstrual cramps) or secondary (caused by an underlying reproductive health issue).
 Menorrhagia: Is characterized by abnormally heavy or prolonged menstrual
bleeding. It can be caused by hormonal imbalances, uterine fibroids, or other
conditions.
 Premenstrual Syndrome(PMS) and Premenstrual Dysphoric Disorder(PMDD):
Involves a range of physical and emotional symptoms before menstruation, while
PMDD is a severe form of PMS that can significantly impact daily functioning.
 Complications cont.

 Cervical Dysplasia:
Cervical dysplasia is the abnormal growth of cells on the cervix, often linked to
human papillomavirus (HPV) infection. If left untreated, it can progress to
cervical cancer.
 Complications cont.

 Gynecological Cancer: Cancers such as ovarian cancer, uterine cancer, and

cervical cancer can affect the female reproductive system and may require
surgery, chemotherapy, or radiation therapy.
 Ectopic Pregnancy:
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus,
usually in a fallopian tube. It poses a serious health risk and requires immediate
medical attention.
 Possible abnormal things that can occur in the female reproductive
system:

There are several congenital abnormalities that can affect the female reproductive system.
These conditions are present at birth and may impact the development and function of
reproductive organs. Here are some examples:
 Turner Syndrome: This genetic disorder affects females and is characterized by the
partial or complete absence of one of the X chromosomes. It can lead to
underdeveloped ovaries, short stature, and infertility.
 Mullerian Anomalies: These are abnormalities in the development of the Müllerian
ducts, which give rise to the female reproductive organs. Examples include:
 Septate Uterus: A partition or wall within the uterus.
 Bicornuate Uterus: Uterus with two separate horns.
 Unicornuate Uterus: Uterus that forms only on one side.
 Abnormal things cont.
 Androgen in sensitivity Syndrome (AIS): Is a genetic condition where an individual with
XY chromosomes (typically male) is partially or completely insensitive to androgens (male
hormones). In complete AIS, individuals may have external female genitalia but no
functional uterus or ovaries.
 Congenital Adrenal Hyperplasia (CAH): CAH is a group of genetic disorders affecting
the adrenal glands, leading to abnormal hormone production. In females, it can cause
virilization (development of male secondary sexual characteristics) and affect the
development of reproductive organs.
 Vaginal Agenesis: This condition involves the incomplete or absent development of the
vagina. It may be associated with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome,
where the uterus is either absent or underdeveloped.
 Abnormal things cont.
 Ovarian Dysgenesis: Ovarian dysgenesis is a condition where the ovaries do not
develop properly. It can result in hormonal imbalances and may lead to primary
amenorrhea and infertility.
 Gonadal Dysgenesis: This condition involves abnormal development of the
gonads (ovaries or testes). It can result in ambiguous genitalia or underdeveloped
reproductive organs.
 Double Uterus (Didelphys Uterus): In this condition, a woman has two separate
uteri, each with its own cervix. It can be associated with a double or partially
double vagina.
 Management:
The management of reproductive complications will depend on the subjective and
objective data collected.
Note: for History of present illness, you can follow the acronym below, P. Q. R. S For
example;
Pain Description: Ask the patient to describe the pain, including its location, intensity,
quality (e.g., cramping, sharp), and radiation. Pain scales, like the Numeric Rating Scale
(NRS) or Visual Analog Scale (VAS), may be used to quantify pain intensity.
Onset and Duration: Ask about when the pain started, its duration, and whether there
are specific triggers or patterns associated with the pain.
 Management cont.

 Aggravating or Alleviating Factors: Explore factors that worsen or alleviate the

pain, such as specific activities, medications, or rest.
 Associated Symptoms: Inquire about other symptoms accompanying
dysmenorrhea, such as nausea, vomiting, diarrhea, headaches, or dizziness.
 Impact on Daily Activities: Assess how dysmenorrhea affects the patient's daily
life, including work, school, and social activities.
 Vital Signs: Measure the patient's vital signs, including heart rate, blood pressure,
respiratory rate, and body temperature. These can provide insights into the
physiology of the disease.
 Management cont.

 Physical Examination: Conduct a pelvic examination to check for

abnormalities, tenderness, or signs of reproductive health issues.
 Laboratory Tests: often a clinical diagnosis is obtained after doing certain
laboratory tests like culture and sensitivity, full blood count and others.
 Nursing diagnosis and Nursing intervention are done In order to solve the
presenting health problem.
Conclusion
Understanding the anatomy and physiology of the female reproductive system,
plus having skills of assessing the female reproductive system give a clear
picture on how to diagnose, manage and solve the maternal and child
reproductive health issues hence minimizing the incidences of maternal and
child morbidities and mortalities.
 References:
Carolyn J. (2020), Physical Examination and Health Assessment, 8th edition, E-
Book-Elsevier Inc. (2020).
Development of the female reproductive system, available at;
https://www.youtube.com/watch?v=gmK1XYVm8xM