16 Focused Assessment: Reproductive Assessment

I. Overview of the male and female male reproductive Systems

Adolescence is a period that begins with puberty and ends with the transition to adulthood (approximately ages 10–20). Physical changes associated with puberty are triggered by hormones. Cognitive changes include improvements in complex and abstract thought, as well as the development that happens at different rates in distinct parts of the brain and increases adolescents’ propensity for risky behavior because increases in sensation-seeking and reward motivation precede increases in cognitive control.

Initially, there is a  growth spurt, followed by the first part of sexual maturity where primary sexual characteristics develop and changes to the internal reproductive organs occur.

• For males, there is growth to the testes, penis, scrotum, and spermarche or the first ejaculation of semen occurs. This occurs between 11 and 15 years of age.
• For females, the uterus grows and menarche or the first menstrual period occurs. The female gametes, which are stored in the ovaries, are present at birth but are immature. Beginning at puberty, one ovum ripens and is released about every 28 days during the menstrual cycle. Stress and a higher percentage of body fat can bring menstruation at younger ages.

The second part of sexual maturity occurs with the visibility of secondary sexual characteristics. These are physical changes not directly linked to reproduction, but signal sexual maturity.

• For males, this includes broader shoulders and a lower voice as the larynx grows. Hair becomes coarser and darker, and hair growth occurs in the pubic area, under the arms, and on the face.
• For females breast development occurs around age 10, although full development takes several years. Hips broaden and pubic and underarm hair develops and also becomes darker and coarser.

Cultural differences are noted with African American girls enter puberty the earliest, followed by Hispanic girls, then European-American, and lastly Asian-American girls.  Although African- American girls are typically the first to develop, they are less likely to experience negative consequences of early puberty when compared to European-American girls (Weir, 2016).

Tanner Scale of secondary sex organs by age for males and females

The Tanner staging scale is also known as the Sexual Maturity Rating (SMR) chart. This is an objective classification system used by Pediatricians and other health care providers to track and document the development of a patient’s secondary sex characteristics as these change from those of a child through puberty to those of an adult.

https://en.wikipedia.org/wiki/Tanner_scale

II. Anatomy and Physiology

Male Reproductive System:

Males have both internal and external genitalia that are responsible for procreation and sexual intercourse. Males produce their sperm on a cycle, and unlike the female’s ovulation cycle, the male sperm production cycle is constantly producing millions of sperm daily. The main male sex organs are the penis and the testicles, the latter of which produce semen and sperm.

Male anatomy with secondary sex characteristics.

Click on this link to watch the video on the male reproduction system if the video is not present:

Female external genitalia is collectively known as the vulva, which includes the mons veneris, labia majora, labia minora, clitoris, vaginal opening, and urethral opening. Female internal reproductive organs consist of the vagina, uterus, fallopian tubes, and ovaries. The uterus hosts the developing fetus, produces vaginal and uterine secretions, and passes the male’s sperm through to the fallopian tubes while the ovaries release the eggs. The vagina is attached to the uterus through the cervix, while the uterus is attached to the ovaries via the fallopian tubes.

Female  Reproductive System:

Click on this link to watch the video on the male reproduction system if the video is not present:

III. Medical Terminology:

IV. Step by Step Assessment

• Perform hand hygiene.
• Introduce yourself to the patient.
• Confirm patient ID using two patient identifiers (e.g., name and date of birth).
• Explain the process to the patient.
• Use appropriate listening and questioning skills.
• Listen and attend to patient cues.
• Ensure patient’s privacy and dignity.
• Apply principles of asepsis and safety.
• Check vital signs.

Conduct a focused reproduction system health history:     

1. Present complaint.
2. History of chief complaint.
3. Menstrual history:   Age of Menarche?  Last Monthly Period (LMP)?  Any changes or pain related to menstruation?
4. Past Gynecological history:  Age at which puberty begins/began? How old was the patient when the first sexual encounter occurred and how many sexual partners has the patient had?  Sexual history and if sexually active what type of contraception is being used? Acute or chronic diseases related to the reproductive system including Sexually Transmitted Infection (STIs)?  Personal history of reproductive problems?  Menopause: At what age did menses slow, become irregular, or stop? What symptoms are occurring? How are the menopausal symptoms being treated? Is there vaginal dryness or irritation?  Is Estrogen Replacement Therapy being used?  Is there any spotting or bleeding?
5.  Obstetrics History: The number of pregnancies and births. Type of delivery for each birth? Any complications from pregnancy, delivery, or postpartum.
6. Past Medical, Surgical, and Social histories.
7. Family history of reproductive problems including infertility, complications during birthing, and genetic or congenital diseases.
8. Medication and Drug history.
9. Nutritional history: malnutrition and some diet-related diseases e.g. Iron deficiencies can cause fatigue and low libido.
10. Personal History:  Reproductive wellness check: How often are external and internal genitalia assessed by a health care provider? How often is the patient performing self-assessment of breast, female or male genitalia? Female Problem History: Any pain or tenderness with ovulation, pre, during, or post menses (period), during or after sex? Any new lesions to external or internal genitalia? Any history of abnormal breast exams, pelvic exams, or Pap smears? Any new vaginal discharge, or itching? Any spotting or bleeding between menstrual periods? Any burning or irritation with urination? Any rectal lesions, warts, hemorrhoids, or bleeding?  Any mood, psychological or behavioral changes noted pre, during, or post menses? Male Problem History: Any new lesions or masses to external genitalia? Any new penile discharge, or itching?  Any difficulty, hesitancy, urgency, or burning with urination?  Any difficulty with obtaining and maintaining an erection?  Any history of Prostate problems including Benign Prostatic Hypertrophy (BPH) or disease? Any rectal lesions, warts, hemorrhoids, or bleeding?
11. Breast History: Any breast tenderness of pain and for women is it associated with ovulation or menstruation? Any recent change in breast tissue or lumps palpated to breast or axillary-again for women is this associated with ovulation or menstruation? Any nipple discharge? Any axillary Tenderness? Any risk factors for breast cancer including Aging, genetic mutations, Menarche before 12 and menopause before 55, Dense breast, history of breast cancer or certain ono-cancerous diseases, family history of breast cancer, previous radiation therapy, and the use of the drug diethylstilbestrol.

Most of the questions listed above are now asked via a question sheet that is filled in while waiting to be seen by the Health Care Provider and the answers are reviewed and confirmed by the Health Care Provider when seen. Here is an example:

Obstetrics and Gynecology/Gynecological History Taking

Martin Sauter, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wiki

^{Note: Click all hyperlinks to access more details.}

Ethical-legal aspects of the reproductive system assessment include physical, emotional, and psychological safety, privacy, HIPAA, laws governing new procedures to assist with conceiving, ethical and moral conflicts as it relates to abortion, Laws concerning the need for parental consent for birth control, and abortion. As nurses, we also need to be aware of the laws concerning the physical and sexual abuse of minors.  Another consideration is the mindfulness of culture and religion when caring for the reproductive health of women who cannot be examined without a male relative in the room.

A more detailed overview of the different ethical-legal aspects of the reproductive system assessment will be available at:

Mobile Phones in Research and Treatment: Ethical Guidelines and Future Directions

Phones are not allowed in all care settings to protect patient privacy and enforce HIPAA and think about the invasiveness of the reproductive system.

Disrupted prevention: condom and contraception access and use among young adults during the initial months of the COVID-19 pandemic. An online survey

V. Documentation of Assessment Findings

VI. Related Laboratory and Diagnostic Procedures/Findings

Examination of the male and female reproductive system will include the following test:

• Complete Blood Count (CBC) to assess for Anemia through blood loss or indicate any kind of bleeding or clotting problem or infections
• Basis Metabolic Pane: to assess hydration, electrolyte, kidney function, and glucose level. Here is an article to understand more about lab values: https://www.uofmhealth.org/health-library/tr6153
• Urine test- What Your Urine Says About You and Your Health  Here is a great article for further understanding of the urinalysis test:  https://www.ncbi.nlm.nih.gov/books/NBK557685/
• Pap Smear: to assess the cell on and around the cervix of the uterus for abnormal cells. Here is a great article for further understanding of the Pap Smear: https://www.mayoclinic.org/tests-procedures/pap-smear/about/pac-20394841
• Brest exam and a monthly self-examination to assess for changes in breast skin, shape, size, pain and lump, and changes to the nipple.
• The male patient- testicular and prostate checks. Testicular self-checks to check for changes in the feel of tissue.

VII. Learning Exercises:

Exercises

VIII. Attributions and Reference

Stoppler, M., C. Puberty    https://www.medicinenet.com/puberty/article.htm

Lansford, J., Lifespan Development. Module 7: Adolescence https://courses.lumenlearning.com/suny-lifespandevelopment2/chapter/introduction-to-adolescense/

Lally M., and Valentine-French, S. Lifespan Development. Sexual Development https://courses.lumenlearning.com/suny-lifespandevelopment/chapter/sexual-development/

Sexual Development  https://courses.lumenlearning.com/suny-lifespandevelopment/chapter/sexual-development/

Tanner Scale  https://en.wikipedia.org/wiki/Tanner_scale

Introduction to Adolescence  https://courses.lumenlearning.com/suny-lifespandevelopment2/chapter/introduction-to-adolescense/

My First Time: A Girl’s Guide to Vising Her Gynecologist https://www.aoafamily.com/home/news-topic.php?newsid=195

Female reproductive sys, menstruation & fertilisation | How do organisms reproduce | Khan Academy  https://youtu.be/bj-fF5cIVYk

Male reproduction system: https://vimeo.com/204303895

Performing the male genital exam_English Version https://vimeo.com/nctcfp/male-genital-exam-eng

The 5-minute Pelvic exam- https://vimeo.com/111934771

Breast Cancer Screening Guidelines for Women: https://www.cdc.gov/cancer/breast/pdf/breast-cancer-screening-guidelines-508.pdf

How Often Should Women Get a Breast Exam? https://www.toplinemd.com/breast-care-center-of-miami/blog/how-often-should-women-get-a-breast-exam/

Practices of Breast Self-Examination and Associated Factors among Female Debre Berhan University Students https://www.hindawi.com/journals/ijbc/2017/8026297/

The Ethical, Legal, and Social Issues Impacted by Modern Assisted Reproductive Technologies  https://www.hindawi.com/journals/ogi/2012/686253/

Genetic Testing between Private and Public Interests: Some Legal and Ethical Reflections  https://www.frontiersin.org/articles/10.3389/fpubh.2018.00008/full

The Possible Dangers of Prenatal Nonmedical Sex Selection in regard to in vitro Fertilization https://madridge.org/journal-of-womens-health-and-emancipation/mjwh-1000112.php

Mobile Phones in Research and Treatment: Ethical Guidelines and Future Directions  https://mhealth.jmir.org/2015/4/e95/

University of Michigan Health Michigan Medicine. Comprehensive Metabolic Panel September 23, 2020 https://www.uofmhealth.org/health-library/tr6153

Mayo Clinic Staff. Patient care & Health Information Pap Smear https://www.mayoclinic.org/tests-procedures/pap-smear/about/pac-20394841

Female Anatomy https://commons.wikimedia.org/wiki/File:Blausen_0400_FemaleReproSystem_02.png