55
Assessment: Reproductive System
Ashton T. Strachan
http://evolve.elsevier.com/Lewis/medsurg/
CONCEPTUAL FOCUS
Hormonal Regulation Sexuality
Reproduction
LEARNING OUTCOMES
1. Describe the structures and functions of the male and 5. Obtain significant subjective and objective data related
female reproductive systems. to the reproductive system and information about sexual
2. Outline the functions of the major hormones essential function.
for the functioning of the male and female reproductive 6. Perform a physical assessment of the reproductive system
systems. using the appropriate techniques.
3. Explain the physiologic changes during the stages of a 7. Distinguish normal from common abnormal findings of a
sexual response. physical assessment of the reproductive system.
4. Link the age-related changes of the reproductive system to 8. Describe the purpose, significance of results, and nursing
the differences in assessment findings. responsibilities related to diagnostic studies of the
reproductive system.
KEY TERMS
amenorrhea menstrual cycle
epididymis progesterone
estrogen spermatogenesis
gonads testosterone
menarche uterus
menopause vulva
STRUCTURES AND FUNCTIONS OF MALE AND female reproductive tract, and (3) hormone secretion. The pri-
mary male organs are the testes. Secondary organs include ducts
FEMALE REPRODUCTIVE SYSTEMS (epididymis, ductus deferens, ejaculatory duct, urethra), sex
The male and female reproductive systems consist of primary glands (prostate gland, Cowper glands, seminal vesicles), and
(essential) organs and secondary (accessory) organs. The pri- the external genitalia (scrotum, penis) (Fig. 55.1).
mary reproductive organs are the gonads. The female gonads are
the ovaries. The male gonads are the testes. The main purpose of Testes
the gonads is secretion of hormones and production of gametes The paired testes are ovoid, smooth, firm organs. They measure
(ova and sperm, sex cells that unite during fertilization to form a 1.4 to 2.2 in (3.5 to 5.6 cm) long and 0.8 to 1.2 in (2 to 3 cm)
new cell called a zygote). Secondary organs begin their maturity at wide. They lie within the scrotum. It is a loose protective sac
puberty under the influence of sex hormones. They are responsi- composed of a thin outer layer of skin over a tough connec-
ble for (1) transporting and nourishing the ova (eggs) and sperm, tive tissue layer. Within the testes, coiled structures, called the
and (2) preserving and protecting the fertilized ova. seminiferous tubules, form spermatozoa (immature sperm). The
process of sperm production is called spermatogenesis. Males
Male Reproductive System make sperm throughout their reproductive life cycle. Interstitial
The 3 main roles of the male reproductive system are (1) sperm cells lie between the seminiferous tubules. These cells make the
production and transportation, (2) deposition of sperm in the male sex hormone, testosterone.
1352
, CHAPTER 55 Assessment: Reproductive System 1353
Ureter
Seminal vesicle
Bladder
Ejaculatory duct
Pubic symphysis
Prostate gland Ductus
deferens
Rectum
Urethra
Cowper’s gland
Anus Penis
Epididymis
Testis Glans
Scrotum
Fig. 55.1 Male reproductive tract. (Modified from Patton KT, Thibodeau GA: Anatomy and physiology, ed 8,
St Louis, 2013, Mosby.)
Nerves and
a connective tissue sheath that encloses the ductus deferens,
blood vessels in
Epididymis arteries, veins, nerves, and lymph vessels as it ascends through
the spermatic cord Seminiferous the inguinal canal (Fig. 55.2). In the abdominal cavity, the duc-
tubules tus deferens travels up, over, and behind the bladder. Behind the
Testis bladder, the ductus deferens joins the seminal vesicle to form
the ejaculatory duct (Fig. 55.1).
The ejaculatory duct passes downward through the prostate
gland, connecting with the urethra. The urethra extends from
the bladder, through the prostate, and ends in a slit-like opening
(the meatus) on the ventral side of the glans, the tip of the penis.
During ejaculation, sperm travel through the urethra and out
Ductus (vas) of the penis.
deferens
Glands
The seminal vesicles, prostate gland, and Cowper (bulboure-
thral) glands are the accessory glands. These glands make and
Septum Lobule secrete seminal fluid (semen), which surrounds the sperm and
Fig. 55.2 Seminiferous tubules, testis, epididymis, and ductus (vas) forms the ejaculate. The ejaculate fluid serves as a medium for
deferens in the male. (Modified from Patton KT, Thibodeau GA: Anat-
omy and physiology, ed 8, St Louis, 2013, Mosby.)
the transport of sperm. It creates an alkaline, nutritious envi-
ronment that promotes sperm motility and survival.
The seminal vesicles lie behind the bladder, between the
Ducts bladder and rectum. The ducts of the seminal vesicles fuse with
Sperm formed in the seminiferous tubules move through a the ductus deferens to form the ejaculatory ducts. They enter
series of ducts. These ducts transport sperm from the testes to the prostate gland, which lies beneath the bladder. Its posterior
the outside of the body. As sperm exit the testes, they enter and surface is in contact with the rectal wall. The prostate normally
pass through the epididymis, ductus deferens, ejaculatory duct, measures 0.8 in (2 cm) wide and 1.2 in (3 cm) long. It is divided
and urethra. into right and left lateral lobes and an anteroposterior median
The epididymis is a comma-shaped structure found behind lobe. Cowper glands lie on each side of the urethra and slightly
and on top of each testis within the scrotum (Figs. 55.1 and behind it, just below the prostate. The ducts of these glands
55.2). It is a long, tightly coiled structure that, uncoiled, mea- enter directly into the urethra.
sures about 20 ft in length.1 The epididymis transports sperm
as they mature. Sperm exit the epididymis through a long, thick External Genitalia
tube called the ductus deferens. The external male genitalia consist of the penis and scrotum.
The ductus deferens (also called the vas deferens) is continu- The penis consists of a shaft and tip, called the glans. The glans
ous with the epididymis within the scrotal sac. It travels upward is covered by a fold of skin, the prepuce (or foreskin), that forms
through the scrotum and continues through the inguinal ring at the junction of the glans and shaft of the penis. In circum-
into the abdominal cavity. The spermatic cord is composed of cised males, the prepuce has been removed. The shaft consists
, 1354 SECTION 11 Problems Related to Regulatory and Reproductive Mechanisms
Fallopian tube Ureter Sacrum
Ovary
Body of uterus Uterosacral
Fundus of uterus ligament
Round ligament
Bladder
Cervix
Symphysis pubis
Urethra
Vagina
Rectum
Vaginal introitus
Anus
Fig. 55.3 Female reproductive tract. (Modified from McKenry L, Tessier E, Hogan M: Mosby’s pharmacology
in nursing, St Louis, 2006, Mosby.)
of erectile tissue composed of the corpus cavernosum, corpus ruptured ovarian follicle (ovulation) into the fallopian tube. The
spongiosum (fibrous sheath that encases the erectile tissue), and tubes, which average 4.8 in (12 cm) in length, extend from the
urethra. The skin covering the penis is thin, loose, and hairless. fimbriae to the superior lateral borders of the uterus.
Normally, each month during a woman’s reproductive years,
Female Reproductive System 1 ovarian follicle reaches maturity. That ovum is ovulated, or
The 3 main roles of the female reproductive system are (1) ova expelled, from the ovary through the stimulus of the gonad-
production, (2) hormone secretion, and (3) protect and facili- otropic hormones: follicle-stimulating hormone (FSH) and
tate the development of the fetus in a pregnant female. The pri- luteinizing hormone (LH). The ovum then travels through a
mary female organs are the paired ovaries. Secondary organs fallopian tube, where fertilization by sperm may occur (if sperm
include the ducts (fallopian tubes), uterus, vagina, sex glands are present). Fertilization usually takes place within the outer
(Bartholin glands, breasts), and external genitalia (vulva). one third of the fallopian tubes. An ovum can be fertilized up to
72 hours after its release.
Pelvic Organs Uterus. The uterus is a pear-shaped, hollow, muscular organ
Ovaries. The ovaries are found on either side of the uterus, found between the bladder and rectum (Fig. 55.3). In the
just behind and below the fallopian tubes (Fig. 55.3). The mature nulliparous (never pregnant) woman, the uterus is about
almond-shaped ovaries are firm and solid. They are around 0.6 2.4 to 3.2 in (6 to 8 cm) long and 1.6 in (4 cm) wide. The uterine
in (1.5 cm) wide and 1.2 in (3 cm) long. Their functions include walls consist of an outer serosal layer, the perimetrium; a middle
ovulation and secretion of the 2 major reproductive hormones: muscular layer, the myometrium; and an inner mucosal layer,
estrogen and progesterone. the endometrium.
The outer zone of the ovary has follicles with germ cells, or The uterus consists of the fundus, body (or corpus), and
oocytes. Each follicle contains a primordial (immature) oocyte cervix (Fig. 55.3). The body makes up about 80% of the uterus.
surrounded by granulosa and theca cells. These 2 layers pro- It connects with the cervix at the isthmus, or neck. The cer-
tect and nourish the oocyte until the follicle reaches maturity vix is the lower part of the uterus. It projects into the anterior
and ovulation occurs. However, not all follicles reach matu- wall of the vaginal canal. It makes up about 15% to 20% of
rity. In a process termed atresia, most of the immature folli- the uterus in the nulliparous female. The cervix consists of the
cles become smaller and are reabsorbed by the body. Thus, the ectocervix, the outer part that protrudes into the vagina, and
number of follicles declines from 700,000 at birth to around the endocervix, the canal in the opening of the cervix. The cer-
300,000 at menarche (first menstruation).2 This is the female’s vical canal is 0.8 to 1.6 in (2 to 4 cm) long. The opening of the
lifetime supply of sex cells. As a woman ages, the number and cervix is the cervical os (Fig. 55.4).
quality of oocytes decline. A normal healthy woman releases The ectocervix is covered with squamous epithelial cells. This
around 300 to 500 oocytes by ovulation during the reproduc- gives it a smooth, pinkish appearance. The endocervix is lined
tive years.3 with columnar epithelial cells, which give it a rough, reddened
Fallopian tubes. The fallopian tubes transport the ovum appearance. The junction at which the 2 types of epithelial cells
toward the uterus, facilitating fertilization or implantation. The (squamous and columnar) meet is the squamocolumnar junc-
tubes are uterine appendages that end by curling around the tion (Fig. 55.4). Cells sampled from the squamocolumnar junc-
ovary. The distal ends of the fallopian tubes consist of fingerlike tion are examined as part of a Papanicolaou (Pap) test, which is
projections called fimbriae. They sweep the ovum from the part of cervical cancer screening.
Assessment: Reproductive System
Ashton T. Strachan
http://evolve.elsevier.com/Lewis/medsurg/
CONCEPTUAL FOCUS
Hormonal Regulation Sexuality
Reproduction
LEARNING OUTCOMES
1. Describe the structures and functions of the male and 5. Obtain significant subjective and objective data related
female reproductive systems. to the reproductive system and information about sexual
2. Outline the functions of the major hormones essential function.
for the functioning of the male and female reproductive 6. Perform a physical assessment of the reproductive system
systems. using the appropriate techniques.
3. Explain the physiologic changes during the stages of a 7. Distinguish normal from common abnormal findings of a
sexual response. physical assessment of the reproductive system.
4. Link the age-related changes of the reproductive system to 8. Describe the purpose, significance of results, and nursing
the differences in assessment findings. responsibilities related to diagnostic studies of the
reproductive system.
KEY TERMS
amenorrhea menstrual cycle
epididymis progesterone
estrogen spermatogenesis
gonads testosterone
menarche uterus
menopause vulva
STRUCTURES AND FUNCTIONS OF MALE AND female reproductive tract, and (3) hormone secretion. The pri-
mary male organs are the testes. Secondary organs include ducts
FEMALE REPRODUCTIVE SYSTEMS (epididymis, ductus deferens, ejaculatory duct, urethra), sex
The male and female reproductive systems consist of primary glands (prostate gland, Cowper glands, seminal vesicles), and
(essential) organs and secondary (accessory) organs. The pri- the external genitalia (scrotum, penis) (Fig. 55.1).
mary reproductive organs are the gonads. The female gonads are
the ovaries. The male gonads are the testes. The main purpose of Testes
the gonads is secretion of hormones and production of gametes The paired testes are ovoid, smooth, firm organs. They measure
(ova and sperm, sex cells that unite during fertilization to form a 1.4 to 2.2 in (3.5 to 5.6 cm) long and 0.8 to 1.2 in (2 to 3 cm)
new cell called a zygote). Secondary organs begin their maturity at wide. They lie within the scrotum. It is a loose protective sac
puberty under the influence of sex hormones. They are responsi- composed of a thin outer layer of skin over a tough connec-
ble for (1) transporting and nourishing the ova (eggs) and sperm, tive tissue layer. Within the testes, coiled structures, called the
and (2) preserving and protecting the fertilized ova. seminiferous tubules, form spermatozoa (immature sperm). The
process of sperm production is called spermatogenesis. Males
Male Reproductive System make sperm throughout their reproductive life cycle. Interstitial
The 3 main roles of the male reproductive system are (1) sperm cells lie between the seminiferous tubules. These cells make the
production and transportation, (2) deposition of sperm in the male sex hormone, testosterone.
1352
, CHAPTER 55 Assessment: Reproductive System 1353
Ureter
Seminal vesicle
Bladder
Ejaculatory duct
Pubic symphysis
Prostate gland Ductus
deferens
Rectum
Urethra
Cowper’s gland
Anus Penis
Epididymis
Testis Glans
Scrotum
Fig. 55.1 Male reproductive tract. (Modified from Patton KT, Thibodeau GA: Anatomy and physiology, ed 8,
St Louis, 2013, Mosby.)
Nerves and
a connective tissue sheath that encloses the ductus deferens,
blood vessels in
Epididymis arteries, veins, nerves, and lymph vessels as it ascends through
the spermatic cord Seminiferous the inguinal canal (Fig. 55.2). In the abdominal cavity, the duc-
tubules tus deferens travels up, over, and behind the bladder. Behind the
Testis bladder, the ductus deferens joins the seminal vesicle to form
the ejaculatory duct (Fig. 55.1).
The ejaculatory duct passes downward through the prostate
gland, connecting with the urethra. The urethra extends from
the bladder, through the prostate, and ends in a slit-like opening
(the meatus) on the ventral side of the glans, the tip of the penis.
During ejaculation, sperm travel through the urethra and out
Ductus (vas) of the penis.
deferens
Glands
The seminal vesicles, prostate gland, and Cowper (bulboure-
thral) glands are the accessory glands. These glands make and
Septum Lobule secrete seminal fluid (semen), which surrounds the sperm and
Fig. 55.2 Seminiferous tubules, testis, epididymis, and ductus (vas) forms the ejaculate. The ejaculate fluid serves as a medium for
deferens in the male. (Modified from Patton KT, Thibodeau GA: Anat-
omy and physiology, ed 8, St Louis, 2013, Mosby.)
the transport of sperm. It creates an alkaline, nutritious envi-
ronment that promotes sperm motility and survival.
The seminal vesicles lie behind the bladder, between the
Ducts bladder and rectum. The ducts of the seminal vesicles fuse with
Sperm formed in the seminiferous tubules move through a the ductus deferens to form the ejaculatory ducts. They enter
series of ducts. These ducts transport sperm from the testes to the prostate gland, which lies beneath the bladder. Its posterior
the outside of the body. As sperm exit the testes, they enter and surface is in contact with the rectal wall. The prostate normally
pass through the epididymis, ductus deferens, ejaculatory duct, measures 0.8 in (2 cm) wide and 1.2 in (3 cm) long. It is divided
and urethra. into right and left lateral lobes and an anteroposterior median
The epididymis is a comma-shaped structure found behind lobe. Cowper glands lie on each side of the urethra and slightly
and on top of each testis within the scrotum (Figs. 55.1 and behind it, just below the prostate. The ducts of these glands
55.2). It is a long, tightly coiled structure that, uncoiled, mea- enter directly into the urethra.
sures about 20 ft in length.1 The epididymis transports sperm
as they mature. Sperm exit the epididymis through a long, thick External Genitalia
tube called the ductus deferens. The external male genitalia consist of the penis and scrotum.
The ductus deferens (also called the vas deferens) is continu- The penis consists of a shaft and tip, called the glans. The glans
ous with the epididymis within the scrotal sac. It travels upward is covered by a fold of skin, the prepuce (or foreskin), that forms
through the scrotum and continues through the inguinal ring at the junction of the glans and shaft of the penis. In circum-
into the abdominal cavity. The spermatic cord is composed of cised males, the prepuce has been removed. The shaft consists
, 1354 SECTION 11 Problems Related to Regulatory and Reproductive Mechanisms
Fallopian tube Ureter Sacrum
Ovary
Body of uterus Uterosacral
Fundus of uterus ligament
Round ligament
Bladder
Cervix
Symphysis pubis
Urethra
Vagina
Rectum
Vaginal introitus
Anus
Fig. 55.3 Female reproductive tract. (Modified from McKenry L, Tessier E, Hogan M: Mosby’s pharmacology
in nursing, St Louis, 2006, Mosby.)
of erectile tissue composed of the corpus cavernosum, corpus ruptured ovarian follicle (ovulation) into the fallopian tube. The
spongiosum (fibrous sheath that encases the erectile tissue), and tubes, which average 4.8 in (12 cm) in length, extend from the
urethra. The skin covering the penis is thin, loose, and hairless. fimbriae to the superior lateral borders of the uterus.
Normally, each month during a woman’s reproductive years,
Female Reproductive System 1 ovarian follicle reaches maturity. That ovum is ovulated, or
The 3 main roles of the female reproductive system are (1) ova expelled, from the ovary through the stimulus of the gonad-
production, (2) hormone secretion, and (3) protect and facili- otropic hormones: follicle-stimulating hormone (FSH) and
tate the development of the fetus in a pregnant female. The pri- luteinizing hormone (LH). The ovum then travels through a
mary female organs are the paired ovaries. Secondary organs fallopian tube, where fertilization by sperm may occur (if sperm
include the ducts (fallopian tubes), uterus, vagina, sex glands are present). Fertilization usually takes place within the outer
(Bartholin glands, breasts), and external genitalia (vulva). one third of the fallopian tubes. An ovum can be fertilized up to
72 hours after its release.
Pelvic Organs Uterus. The uterus is a pear-shaped, hollow, muscular organ
Ovaries. The ovaries are found on either side of the uterus, found between the bladder and rectum (Fig. 55.3). In the
just behind and below the fallopian tubes (Fig. 55.3). The mature nulliparous (never pregnant) woman, the uterus is about
almond-shaped ovaries are firm and solid. They are around 0.6 2.4 to 3.2 in (6 to 8 cm) long and 1.6 in (4 cm) wide. The uterine
in (1.5 cm) wide and 1.2 in (3 cm) long. Their functions include walls consist of an outer serosal layer, the perimetrium; a middle
ovulation and secretion of the 2 major reproductive hormones: muscular layer, the myometrium; and an inner mucosal layer,
estrogen and progesterone. the endometrium.
The outer zone of the ovary has follicles with germ cells, or The uterus consists of the fundus, body (or corpus), and
oocytes. Each follicle contains a primordial (immature) oocyte cervix (Fig. 55.3). The body makes up about 80% of the uterus.
surrounded by granulosa and theca cells. These 2 layers pro- It connects with the cervix at the isthmus, or neck. The cer-
tect and nourish the oocyte until the follicle reaches maturity vix is the lower part of the uterus. It projects into the anterior
and ovulation occurs. However, not all follicles reach matu- wall of the vaginal canal. It makes up about 15% to 20% of
rity. In a process termed atresia, most of the immature folli- the uterus in the nulliparous female. The cervix consists of the
cles become smaller and are reabsorbed by the body. Thus, the ectocervix, the outer part that protrudes into the vagina, and
number of follicles declines from 700,000 at birth to around the endocervix, the canal in the opening of the cervix. The cer-
300,000 at menarche (first menstruation).2 This is the female’s vical canal is 0.8 to 1.6 in (2 to 4 cm) long. The opening of the
lifetime supply of sex cells. As a woman ages, the number and cervix is the cervical os (Fig. 55.4).
quality of oocytes decline. A normal healthy woman releases The ectocervix is covered with squamous epithelial cells. This
around 300 to 500 oocytes by ovulation during the reproduc- gives it a smooth, pinkish appearance. The endocervix is lined
tive years.3 with columnar epithelial cells, which give it a rough, reddened
Fallopian tubes. The fallopian tubes transport the ovum appearance. The junction at which the 2 types of epithelial cells
toward the uterus, facilitating fertilization or implantation. The (squamous and columnar) meet is the squamocolumnar junc-
tubes are uterine appendages that end by curling around the tion (Fig. 55.4). Cells sampled from the squamocolumnar junc-
ovary. The distal ends of the fallopian tubes consist of fingerlike tion are examined as part of a Papanicolaou (Pap) test, which is
projections called fimbriae. They sweep the ovum from the part of cervical cancer screening.
