Non-infectious Problems in Reproduction & Sexuality Flashcards
(55 cards)
1
Q
Infertility
A
inability to conceive a child or sustain a pregnancy to birth
2
Q
Infertile
A
have not become pregnant after at least 1 year of unprotected sex
3
Q
Subfertility
A
have the potential to conceive but are just less able to do so without additional help
4
Q
Types of Subfertility
A
- Primary Subfertility
- no previous conceptions - Secondary subfertility
- couple was able to
conceive in the past yet could not do so at the present
5
Q
Subfertility Assessment
A
- alcohol, drug and tobacco use
- any exposure to radiation treatment in the past
- current illnesses, especially endocrine diseases
- occupation and work habits
- the couple’s sexual practices, its frequency, and if there are failed
ejaculations - the use of past and present contraceptive measures
- if there are any children from previous relationships
- current health of the reproductive system
6
Q
Male Subfertility Factors
A
- Inadequate Sperm Count
- Impaired Sperm Motility
- Obstruction
- Ejaculation Problems
7
Q
Male Subfertility Factors: Inadequate Sperm Count
A
- Facts
- normal amount of a sperm per milliliter of seminal fluid
should be 20 million
- 50 million sperms should be found
in a single ejaculation
- 50% of the sperm should be motile, and at least 30% must be
in good shape and form
- Men must avoid actions that decrease scrotal heat such because it could lower the sperm count - What can affect sperm count
- cryptorchidism and varicocele
- testicle trauma surgery on the testicles and
endocrine imbalances
8
Q
Male Subfertility Factors: Impaired Sperm Motility
A
- Men with prostate infections develop different compositions
of the seminal fluid that cause the sperm to reduce its motility - Men who have undergone vasectomy develop an autoimmune
reaction that immobilizes the sperm
9
Q
Male Subfertility Factors: Obstruction
A
Causes obstruction:
- Inflammation of the pathway of the spermatozoa such as
mumps orchitis or epididymitis obstructs - Pressure from tumors of those with benign prostatic hypertrophy
10
Q
Male Subfertility Factors: Ejaculation Problems
A
- problems that cause stress to the patient could cause erectile dysfunction or impotence the inability to achieve an erection and ejaculation
- Premature ejaculation which happens before penetration also affects the deposition of the sperm
11
Q
Female Subfertility Factors
A
- Anovulation
- Tubal Transport Problems
- Uterine Problems
- Cervical Problems
- Vaginal Problems
12
Q
Female Subfertility Factors: Anovulation
A
CAUSES
- Genetic abnormalities
- hypogonadism or Turner’s syndrome wherein there are no ovaries that can produce egg cells - Hormonal imbalances
- hypothyroidism interfere with
the interaction between the ovaries, hypothalamus, and the
pituitary gland - overall nutrition of the woman, her weight, and the exercise
- increased blood glucose levels that disturbs the FSH and LH production and lead to ovulation failure - food that the woman eats
- too much protein and saturated fats decrease
her fertility - Stress
- interferes with the
secretion of GnRH and lowers the production of LH and FSH - polycystic ovary syndrome
- The most common cause
- enables the ovary to produce excess testosterone, thereby reducing the production of FSH and LH
- women ovulate only a few times for the entire year
13
Q
Female Subfertility Factors: Tubal Transport Problems
A
CAUSES
- Adhesion or scarring from tubal ligation or salpingitis
- Infection of the pelvic organs or pelvic inflammatory disease
- can furthermore
constrict tubes if left untreated
14
Q
Female Subfertility Factors: Uterine Problems
A
CAUSES:
- Tumors
- block the implantation site of the embryo - Endometriosis
- implantation of the uterine endometrium
- particles of the endometrium regurgitate and
proliferate, which impedes the implantation site of the
embryo - Decrease secretion of estrogen and progesterone from the
ovary
- results in inadequate formation of the endometrium
- results in interference in the growth of the embryo
15
Q
Female Subfertility Factors: Cervical Problems
A
CAUSES:
- cervix becomes infected
- the cervical mucus
becomes too thick to allow penetration of the spermatozoa, thus impeding fertilization - Scar tissues
- caused by a previous D and C also causes problems in the fertility of the woman
16
Q
Female Subfertility Factors: Vaginal Problems
A
- Infection
- causes its pH level to increase, which
in turn causes the destruction of the motility of the sperm - Sperm agglutinating antibodies
- destroy the ability of the sperm to survive in the vaginal
environment
- cause immobilization of the sperm
17
Q
Subfertility Diagnosis: Semen Analysis
A
- After 2 to 4 days of sexual abstinence the male must ejaculate through masturbation into a clean and dry specimen cup
- time it takes to examine the specimen is at least 1 hour while the sperm are being counted
- normal amount of sperm in every ejaculation should reach
20 million spermatozoa in every milliliter of seminal fluid - analysis is repeated after 2 to 3 months because
spermatogenesis is a process that goes on and on, and the new sperm would reach its maturity after 30 to 90 days
18
Q
Subfertility Diagnosis: Sperm Penetration Assay
A
- performed to ascertain if a man’s sperm could
reach an ovum and be able to penetrate it effectively - Through the aid of an assistive reproductive technique like IVF,
the sperm could be directly injected into the woman’s ovum if they are poorly motile
19
Q
Subfertility Diagnosis: Ovulation Monitoring
A
- most inexpensive test for fertility
- woman is instructed to monitor and record her BBT daily for four months
- BBT is determined by taking the temperature of a woman before she gets up in the morning and before performing any activity
- woman should record her daily temperature and take note of any conditions that affect the rise and fall of her
temperature - During ovulation, the temperature level dips slightly then rises but not more than the normal level of temperature and
remains at this level for almost 10 days, or 3 to 4 days before the next menstrual flow - defect in the luteal phase is diagnosed When the temperature rise did not last for the approximated time
20
Q
Subfertility Diagnosis: Ovulation Determination Test Kit
A
- over the counter commercial test kits that a woman could buy to assess for her ovulation
- determines the upsurge of LH just before the ovulation
- contains a strip that the woman should dip into her midmorning urine
- strip would change color and the woman should see the indication of the color on the kit’s manual or instructions
21
Q
Subfertility Diagnosis: Tubal Patency
A
- Sonohysterography
- imaging tests that are used
- an ultrasound that specifically views the uterus
- uterus is filled with sterile saline solution, then the vaginal
transducer is inserted into the vagina to inspect the uterus
- procedure can be done anytime during the menstrual cycle
because it is only minimally invasive - Hysterosalpingography
- the inspection of the fallopian tubes using a radiopaque medium
- done after the menstrual flow to avoid the regurgitation of the debris from menstruation up the tube
- Contraindications to this procedure are vagina infections,
cervical infections, and uterine infections
22
Q
Subfertility Nursing Intervention
A
- Correction of the Underlying Problem
- man must refrain from coitus for 7 to 10 days at a time
- avoiding prolonged sitting and hot baths and wearing loose clothing - Reduction of the Presence of Infection
- treated according to the microorganism obtained from culture reports
- trichomonal infections, Metronidazole might be teratogenic early in the pregnancy, so the woman must be cautioned of this
if the couple is suspecting a pregnancy - Hormone Therapy
- used for the disturbance of
ovulation is the administration of GnRH
- Clomiphene citrate is also used to stimulate ovulation
- Administration of human menopausal gonadotropins also
stimulates ovarian follicular growth - Surgery
- most commonly used surgery today is the intrauterine insemination because it most likely results in a viable pregnancy
- Tumors that interfere with the fertility can also be surgically removed, such as myomectomy that removes a myoma
- Diathermy or steroid administration can be performed to correct a tubal insufficiency due to inflammation
- Laparoscopy or laser surgery is also possible for removing peritoneal adhesions or nodules - Therapeutic Insemination
- instillation of the sperm into the reproductive tract so that the woman can conceive - In Vitro Fertilization
- One or more oocytes are aspirated from the woman and are
fertilized by a sperm under laboratory conditions
- for Males who have a low sperm count or females with
abnormalities in their fallopian tubes
- woman is given an ovulation stimulating agent before the
procedure
- ovaries are examined daily through ultrasound beginning at the 10 th day of the menstrual cycle to check the development of the ovarian follicles
- hCG is injected to cause ovulation within 39 to 42 hours Once a follicle has matured
- Aspiration of the oocyte follows, and then the sperm and the
oocyte are mixed and incubated
- the first cell division occurs 40 hours after fertilization
23
Q
Therapeutic Insemination Types
A
- intracervical insemination
- sperm is instilled in the
cervix - intrauterine insemination
- sperm is instilled directly into the uterus - Therapeutic insemination by husband
- uses the sperm of the
husband and is instilled into the reproductive tract of the wife - Therapeutic donor insemination
- uses the sperm of a donor, and this is instilled into the reproductive tract of the woman
24
Q
Sexual
Dysfunctions: Failure to Achieve Orgasm
A
- result of poor sexual technique, concentrating too hard on achievement, or negative attitudes toward sexual
relationships - Treatment is aimed at relieving the underlying cause
- treatment may include instruction and counselling for the couple about sexual feelings and needs
25
Sexual Dysfunctions: Erectile Dysfunction
- formerly referred to as impotence
- inability of a man to produce or maintain an erection long enough for penetration or partner satisfaction
- affects as many as 40% of men by age 40 years and 65% of men by age 65 years
26
Sexual Dysfunctions: Erectile Dysfunction Etiology
- most causes are physical, such as aging, atherosclerosis, or
diabetes, all of which are conditions that limit blood supply to the
supply
- it may also occur as a side effect of certain drugs, such as
antidepressants or after discontinuation of finasteride a drug for
male pattern baldness
- problem is compounded by doubt about the ability to perform and reluctance to discuss the problem with health care providers
27
Sexual Dysfunctions: Erectile Dysfunction Management
1. Medications
- sildenafil citrate (tadalafi Cialas and
vardenafil ( taken up once a day to stimulate penile erection by increasing blood flow
- medications are contraindicated in men with a risk of cardiovascular illness and in those who are taking medications that contain nitrates
2. Testosterone administration, intracavernosal injections of
prostaglandin E 1
- vacuum erection devices, or surgical
implants
3. Avanafil bocks the body protein that prevents blood vessels from expanding This allows blood to enter the penis and become trapped here, leading to an erection during times of sexual excitement
4. Frank discussion about the cause of the problem and currently
available therapies
5. Various herbal products
- fennel extracts are available for women, which may improve sexual libido
6. Vibration or vacuum devices
- available to increase
clitoral enlargement and sexual arousal in women
28
Sexual Dysfunctions: Premature Ejaculation
- ejaculation before the sexual partner’s satisfaction has been
achieved
- applies to both same sex and opposite sex couples
- can be unsatisfactory and frustrating
for both partners
29
Sexual Dysfunctions: Premature Ejaculation Causes
- can be psychological
- Masturbating to orgasm (in which is achieved quickly because of lack of time) may play a role
- doubt about masculinity and fear
of impregnating a partner, which prevent the man from sustaining an erection
30
Sexual Dysfunctions: Premature Ejaculation Management
- sexual counselling to reduce stress
- serotonergic antidepressants, such as mirtazapine Remeron
or dapoxetine may be helpful for alleviating the problem
31
Pain Disorders: Vaginismus
- involuntary contraction of the muscles at the outlet of the vagina
when coitus is attempted, which prohibits penile penetration
- occur in women who have been raped
- result of early learning patterns in sexual relations viewed
as bad or sinful
- do sexual or psychological counseling to reduce this response
32
Pain Disorders: Dyspareunia
- pain during coitus
- occur because of endometriosis, vestibulitis vaginal
infection, or hormonal changes such as those that occur with
menopausal
- psychological component may be present, treatment is
aimed at the underlying cause
33
Cancer
- group of disease characterized by uncontrolled and unregulated
growth of cells
- highest incidence among men is prostate cancer
- highest incidence among women is breast cancer
34
BREAST CANCER RISK FACTORS
- Family history
- Unhealthy diet (high in fat, salt, and sugar)
- Obesity/Overweight
- Woman's age (above 30 years old)
- Woman's age at first pregnancy or those who never had any children
- Smoking and drinking
35
BREAST CANCER S/Sx
- Lump, thickening or swelling of the breast
- Unusual change in the size or shape of the breast
- One breast unusually lower than the other
- Puckering/dimpling of the skin of the breast
- Retraction of the nipple
- A sore in the nipple
36
BREAST CANCER TREATMENT
1. Local therapy
- surgery
- radiation
2. Systemic therapy
- hormone therapy
- chemotherapy
- targeted therapy
37
BREAST CANCER PREVENTION
- Minimize contributing risk factors
- Eat a healthy diet consisting of high-fiber foods (cruciferous vegetables, foods rich in vitamins A and C)
- Get enough exercise (Be active to maintain body muscle's flexibility)
- Maintain ideal body weight
- Undergo mammography and BSE (Breast Self-Examination)
38
Breast Self Examination (BSE) Steps
1. Mirror Check
- Stand in front of a mirror, examine your breasts, and check for any changes in size, shape, color, and position of the breast and nipples
2. Side Check (Arms Raised)
- Raise your arms, examine your breasts, and slowly turn around to examine from the side.
3. Bent-Over Check
- Put your hands over your hips, bend forward, and examine if there is any difference.
4. Nipple Check
- Compress or squeeze the nipple to look for any unusual nipple discharge (blood, pus, or clear fluid).
5. Palpation (Lying Down)
6. Lying Down Check
39
Breast Self Examination (BSE)
recommended for those who are over 20 years old to do monthly 7-10 days after menstrual period
40
Cervical Cancer
- death is less common due to early detection of cell changes by Papanicolaou ( smear
- growth of cells that starts in the cervix
- Various strains of the human papillomavirus, also called HPV play
a role in causing most cervical cancers
41
Cervical Cancer S/Sx
- Early cervical cancer rarely produces symptoms
- may go unnoticed as a thin, watery vaginal discharge often noticed after intercourse or
douching
- discharge, irregular bleeding, or pain or bleeding after sexual intercourse occur, the disease may be advanced
42
Cervical Cancer Prevention
- regular pelvic examinations and Pap tests for all women, especially older women past childbearing age
- Preventive counseling should encourage delaying first intercourse, avoiding HPV infection, engaging only in safer sex,
ceasing smoking, and receiving HPV immunization
43
Cervical Cancer Treatment
1. Conservative treatment
- monitoring
- cryotherapy
(freezing with liquid nitrogen)
- laser therapy
2. loop electrocautery excision procedure (LEEP)
- be used to remove abnormal cells
3. Surgery and radiation treatment
- use depends on the stage of the lesion, the patient’s age and general health, and the judgment and
experience of the provider
44
Prostate Cancer
- most common cancer in men
- African American men have a high risk of prostate cancer and more than twice as likely to die of prostate cancer as men of other racial or ethnic groups
- Endogenous hormones, such as androgens and estrogens, also may be associated with the development of prostate cancer
- familial predisposition may occur in men who have a father or brother previously diagnosed with prostate cancer
45
Prostate Cancer Risk Factors
1. increasing age
- increases rapidly after the age of 50 years
- More than 70 of cases occur in men older
than 65 years
2. racial or ethnic groups
- African American men have a high risk of prostate cancer
furthermore, they are more than twice as likely to die of prostate cancer
3. men whose diet
contains excessive amounts of red meat or dairy products that
are high in fat
46
Prostrate Cancer S/Sx
- early stages rarely produces symptoms
- symptoms that develop from urinary obstruction
occur in advanced disease Prostate cancer tends to vary in its
course
- If the cancer is large enough to encroach on the bladder neck, signs and symptoms of urinary obstruction occur Prostate cancer can spread to lymph nodes and bone
47
Prostrate Cancer Diagnosis
- abnormal finding with the DRE, serum PROSTATE SPECIFIC ANTIGEN ( and
ultrasound guided TRUS with biopsy
- Routine repeated DRE (preferably by the same
examiner) is important because early cancer may be detected as a nodule within the gland or as an extensive hardening in the posterior lobe
48
Prostrate Cancer PREVENTION
- Maintain healthy weight
- Regular exercise
- Balanced diet
- Avoiding smoking
- Limit alcohol and caffeine intake
- Regular screening
49
Prostrate Cancer Treatment
*based on the patient’s life expectancy,
symptoms, risk of recurrence after definitive treatment, size of the tumor Gleason score, PSA level, likelihood of
complications, and patient preference
1. Surgical Management
2. Radiation Therapy
3. Hormonal Strategies
4. Chemotherapy
50
Testicular Abnormalities
- most common cancer diagnosed in men between 15 and 35
years of age
- highly treatable and usually curable form of cancer
- classified as germinal or nongerminal
(stromal)
- Secondary testicular cancers may also occur
51
Testicular Abnormalities Risk Factors
- cryptorchidism (undescended testicles)
- family history of testicular cancer
- personal history of testicular cancer
52
Testicular Abnormalities Symptoms
- appear gradually, with a mass or lump on the
testicle and usually painless enlargement of the testis
- patient may report heaviness in the scrotum, inguinal
area, or lower abdomen
- Gynecomastia may arise because of hCG produced by the
tumor
53
Testicular Abnormalities Prevention
1. Educating young men about testicular cancer and the need for urgent evaluation of any mass or enlargement or unexplained testicular pain is key to early detection
2. Testicular Self-Examination (TSE) should be performed monthly
54
Testicular Self-Examination (TSE) Steps
1. Examine your scrotum monthly
2. Check your family jewels after showering, when the sac is soft and relaxed.
3. Using both hands, gently roll the testicles between your fingers.
- Notice the size, shape and feel of your balls
- Normal testicles will feel soft and move freely inside the scrotum.
4. Any lumps or swelling should be reported to your doctor ASAP. You should also see your doctor if you experience warning include a dull ache in the abdomen or groin, or blood in your semen
55
Testicular Abnormalities Treatment
1. Primary treatment
- removal of the affected testis by orchiectomy through an inguinal incision with a high ligation of the spermatic cord
2. patient is offered the option of implantation of a testicular prosthesis during the orchiectomy
3. “Sperm banking” can be presented as an option for future family planning
