This document discusses various health conditions related to reproduction and sexuality. It begins by covering phimosis, which is tightness of the foreskin that prevents retraction. It then discusses hypospadias, which is when the urethral opening is located behind the glans penis. Finally, it covers cryptorchidism, which is the failure of one or both testes to descend into the scrotum. Nursing management focuses on proper hygiene, activity restrictions, and follow up care for these conditions.

1. Clients with Specific
Health Problems
Related to
Reproduction and
Sexuality

2. Altered Reproductive
Development

3. Phimosis

4. Definition
Tightness of the prepuce (foreskin)
of the penis that prevents the
retraction of the foreskin over the
glans penis. The condition is
usually congenital but it may be the
result of an infection.

5. Symptoms
Foreskin may be:
Red
Swollen
Tender
Difficulty with voiding
Ballooning of the prepuce
Odorous discharge

6. Diagnosis
Physical
Examination

7. Nursing Management
Proper hygiene of the phimotic
foreskin.
Foreskin should not be forcibly
retracted.
NOTE:
Retraction of the tight foreskin can result in
paraphimosis.

8. Other Management
1. Antibiotics
2. Hot soaks
3. Small incision
4. Circumcision
5. Preputioplasty

9. Hypospadias

12. Definition
A condition in which the
opening of the urethra is
located behind glans penis
or anywhere along ventral
surface of the penile shaft.

13. Causes
Hypospadias affects up to 4
in 1,000 newborn boys.
Some cases are passed down
through families. In other
cases the cause is unknown.
Certain hormones

14. Signs and symptoms
Opening of the urethra at a location
other than the tip of the penis
Downward curve of the penis (chordee)
Hooded appearance of the penis
because only the top half of the penis is
covered by foreskin
Abnormal spraying during urination

15. Risk Factors
family history of hypospadias.
infant males born to women of an
advanced age
used in vitro fertilization (IVF) to
conceive

16. Complications
problems learning to use
a toilet properly
can cause difficulty with
sexual intercourse.

17. Tests and diagnosis
Physical
Examination

18. Management
Surgery
best at an early age –bet. 3–18 mos.
infants should not be circumcised
before the procedure- foreskin
tissue may be needed for the
surgery

19. Surgical Procedures
1. GAP- Glans
Approximation
Procedure
2. MAGPI- Meatal
Advancement and
Granuloplasty

20. Objectives of Surgical
Correction
To enhance the child’s ability to void in
the standing position with a straight
stream.
To improve the physical appearance of
the genitalia for psychologic reasons.
To preserve a sexually adequate organ.

21. Nursing Management
 Teach the parents about:
a. Indwelling catheter
a.1. how to empty the urine bag
a.2. avoid kinking and twisting
a.3. blockage of the catheter or stent
b. Stent
b.1 prevent infection
c. Increase fluid intake
d. Activities to be avoided until allowed by the surgeon

22. EPISPADIAS

23. Definition
Epispadias is a rare congenital (present from birth)
defect in the location of the opening of the urethra.
-In boys with epispadias, the urethra generally opens on
the top or side of the penis rather than the tip.
However, it is possible for the urethra to be open the
entire length of the penis.
-In girls, the opening is usually between the clitoris and
the labia, but may be in the belly area.

24. Causes
 Unknown
 Improper development of the pubic bone.
 Can be associated with bladder exstrophy.
 Epispadias can also occur alone or with
defects.
 Occurs in 1 in 117,000 newborn boys and 1 in
484,000 newborn girls.

25. Signs and Symptoms
MALES
 Abnormal opening from the joint between the
pubic bones to the area above the tip of the penis
 Backward flow of urine into the kidney (reflux
nephropathy)
 Short, widened penis with an abnormal curvature
 Urinary tract infections
 Widened pubic bone

26. FEMALES
 Abnormal clitoris and labia
 Abnormal opening where the from the
bladder neck to the area above the normal
urethral opening
 Backward flow of urine into the kidney
(reflux nephropathy)
 Widened pubic bone
 Urinary incontinence
 Urinary tract infections

27. Exams and Tests
Blood test to check electrolyte levels
Intravenous pyelogram (IVP)- a special
x-ray of the kidneys, bladder, and
ureters
Pelvic x-ray
Ultrasound of the urogenital system

28. Treatment
Surgical repair

29. Possible Complications
Persistent urinary incontinence can
occur in some persons with this
condition even after several
operations.
Upper urinary tract (ureter and
kidney) damage and infertility may
occur.

30. CRYPTORCHIDISM

31. Definition
Failure of one or both
testes to descend
normally through the
inguinal canal into the
scrotum.

32. Absence of Testes Can be a Result
of:
1. Undescended testes ( cryptorchid)
2. Retractile testes
3. Anorchism ( absence of testes)

33. Categories of Undescended Testes
According to Location
Abdominal- Proximal to the internal
inguinal ring.
Canalicular- Between the internal and
external inguinal rings.
Ectopic- Outside the normal pathways
of descent between the abdominal
cavity and the scrotum.

34. Incidence
33%- preterm boys
3-4%- full-term boys
1 %- by the age of 1 year

35. Symptoms
Nonpalpable testis
Adult males with an
undescended testicle may have
problems with infertility.

36. Diagnostic Evaluation
Ultrasonography
MRI
Abdominal laparoscopy- most
accurate means for locating
nonpalpable testes
Computed Tomography

37. Therapeutic Management
Trial Hormone Therapy
- Luteinizing hormone-releasing hormone ( nasal
spray)
- Human gonadotropin- (injection)
Orchiopexy- surgery to move an undescended testicle
into the scrotum and permanently fix it there.
- Performed by Pediatric Urologist or Surgeon

38. Surgical Repair is Done to:
1. Prevent damage to the undescended testicle by
exposure to the higher degree of body heat in the
undescended location, thus maintaining future
fertility.
2. Decrease the incidence of malignancy formation,
which is higher in undescended testicles.
3. Avoid trauma and torsion.
4. Close processus vaginalis.
5. Prevent the cosmetic and psychologic handicap of an
empty scrotum.

39. Nursing Management
1. Prevent infection
2.Teach the family about the following:
a. Complications
b. Activity restrictions
3. Suggest follow-up care (boys)
- Especially after puberty
a. Perform TSE

40. HYDROCELE

41. Definition
A hydrocele is a fluid-filled sac
surrounding a testicle that
results in swelling of the
scrotum, the loose bag of
skin underneath the penis.

42. Image

43. Incidence
10 male infants- at birth
Disappear within 1st year of life-
even without treatment
Men — usually older than 40- due
to inflammation or injury within
the scrotum.

44. Symptoms
painless swelling of one
or both testicles
palpable bulge in the
inguinal or scrotal area

45. Communicating Hydrocele
Type of hydrocele common in
newborns
One in which peritoneal fluid may
be forced by intraabdominal
pressure and gravity.
Predispose the child to herniation

46. Risk Factors
Scrotal injury
Infection
Radiation therapy

47. Tests and Diagnosis
Physical Examination
Transillumination
blood and urine tests

48.  Ultrasound imaging.-This test, which uses high-
frequency sound waves to create images of structures
inside your body, may be used to rule out a testicular
tumor or other cause of scrotal swelling.
 Abdominal X-ray- A basic X-ray uses electromagnetic
radiation to make images of your bones, teeth and
internal organs. An X-ray may distinguish a hydrocele
from an inguinal hernia.

49. Complications
Infection or tumor- Either may
impair sperm production or function.
Inguinal hernia- A loop of intestine
could become trapped in the weak
point in the abdominal wall
(strangulated), a life-threatening
condition.

50. Surgical Management
 Surgical excision (hydrocelectomy)
Nursing Responsibilities:
- Inform client to wear bulky dressing over the site
of the incision for a few days after surgery.
- Inform client to wear scrotal support for a time
after surgery.
- Ice Pack application- 24 hours post –op to reduce
swelling

51. Needle aspiration
- treatment isn't widely used
- option for men who have risk factors
that make surgery more dangerous
- Risks of this procedure include
infection and scrotal pain.

52. NOTE:
Surgicalrepair is
indicated if spontaneous
resolution does not take
place by 1 year of age.

53. Sexually Transmitted
Diseases

54. Definition
Infections that are primarily
transmitted by heterosexual
or homosexual intercourse or
by intimate contact with the
mouth, genitalia, or rectum.

56. Most Common
HIV Virus- most deadly
Syphilis
Gonorrhea
Chlamydia

57. Symptom
 Primary infection symptoms
 A sore or a cluster of sores or bumps, with or without pain,
on the genitals or in the oral or rectal area
 Painful or burning urination
 Discharge from the penis
 Vaginal discharge
 Unusual vaginal bleeding
 Sore, swollen lymph nodes, particularly in the groin but
sometimes more widespread
 Fever and other flu-like symptoms

59.  Advanced disease: Months to years after primary infection
 Sores or bumps anywhere on the body
 Recurrent genital sores
 Generalized skin rash
 Pain during intercourse
 Scrotal pain, redness and swelling
 Pelvic pain
 Groin abscess
 Infections associated with human immunodeficiency virus
(HIV)
 Infertility
 For some infections, neurological or cardiovascular problems
 Cancer

60.  Find out your sex partner has an
STD
 Believe you may have been
exposed to an STD
 Develop a genital sore or rash
 Have a discharge from the
vagina or penis
 Have pain or a burning
sensation when you urinate
 Have swollen or tender lymph
nodes in your groin

61.  Bacteria and intestinal parasites that cause rectal and
anal pain, sometimes with severe diarrhea
 Single-celled organisms that cause urethritis, vaginitis,
cervicitis and pelvic inflammatory disease
(Trichomonas vaginalis)
 Viruses that cause cervical and anal cancer (human
papillomavirus, also known as HPV, types 16, 18, 31, 33,
45, 52 and 58)
 Viruses that cause genital herpes (herpes simplex
virus, also known as HSV, usually type 2 but
sometimes type 1)

62. Risk Factors
 Being sexually active
 Starting sexual activity at an early age
 Having high-risk sex
 Currently having an STD
 Having a history of an STD
 Having multiple sex partners, not just
concurrently but over time
 Using alcohol or recreational drugs
 Injecting drugs

63.  Being young
 Being female
 Being African-American
 Having sex with men
 Meeting people in public places or online for sex

64. Cause
 Bacteria that cause gonorrhea
(Neisseria gonorrhea)
 Bacteria that cause syphilis
(Treponema pallidum)
 Bacteria that cause urethritis,
cervicitis and pelvic
inflammatory disease
(Chlamydia trachomatis)

65. Complications
 Arthritis
 Eye inflammation
 Pelvic inflammatory disease
 Infertility
 Cervical cancer
 Other cancers, including HIV-associated lymphoma and HPV-
associated rectal and anal cancers
 Opportunistic infections occurring in advanced HIV
 Heart disease
 Difficulty walking or maintaining balance
 Personality change
 Memory loss
 Maternal-fetal transmission, which causes severe birth defects

66. Diagnostic Exam
GONORRHEA
Culture and sensitivity
Pap smear or cervical smear-
female
Urethral smear- male
Blood Exam- VDRL

67. SYPHILIS
Positive Test for Syphilis
 Venereal Disease Research Laboratory
(VDRL)
 Rapid Plasma Reagin Circle Card Test
 Wasserman Test
Darkfield Examination

68. ACQUIRED IMMUNE DEFICIENCY SYNDROME
 ELISA ( enzyme-linked immunosorbent assay)
 Western Blot- Confirmatory Test

69. Coping and Support
Put blame on hold
Be candid with health care
workers
Keep things in perspective
Contact your health department

70. Prevention
Screening
Everyone
Pregnant women
Young women who are sexually
active
Women ages 21 to 66

71.  Men who have sex with men
 People with HIV
 Vaccination
 Partner notification and preventive treatment

72. Safer SEX
 Don't have sex in any way that puts you and your
partner in direct contact with each other's blood,
semen or other body fluids.
 Avoid vaginal and anal intercourse with new
partners until you have both been tested for STDs.
Oral sex is less risky, but use a latex condom or
dental dam to prevent direct contact between the
oral and genital mucosa.

73. Use a latex condom every time you have
intercourse.
Never use an oil-based lubricant, such
as petroleum jelly, with a latex condom.
Don't drink alcohol or use drugs. If
you're under the influence, you're more
likely to take sexual risks.

74.  Don't look for sex partners online or in bars or
other pickup places.
 Before any serious sexual contact, communicate
with your partner about practicing safer sex. Reach
an explicit agreement about what activities will
and won't be OK.
 Stay with one sex partner who doesn't have any
STDs and who won't have sex with anyone but you.

75. INFERTILITY

76. Definition
Not being able to get
pregnant despite having
frequent, unprotected sex
for at least a year.

77. Symptoms
Inability for a couple to get
pregnant
Irregular menstruations- Women
hormonal problems- Men
a. changes in hair growth
b. sexual function

78. Causes
 In about 20 percent of cases, infertility is
due to a cause involving only the male
partner.
 In about 30 to 40 percent of cases, infertility
is due to causes involving both the male and
female.
 In the remaining 40 to 50 percent of cases,
infertility is due entirely to a cause involving
the female.

79. Male Infertility
 impaired sperm count or mobility
 impaired ability to fertilize the egg
 abnormal sperm production or function
 impaired delivery of sperm
 general health and lifestyle issues
 overexposure to certain environmental
elements.

80. Female Infertility
 Fallopian tube damage or blockage
 Endometriosis
 Ovulation disorders
 Elevated prolactin (hyperprolactinemia).
 Polycystic ovary syndrome (PCOS).
 Early menopause (premature ovarian failure).
 Uterine fibroids.
 Pelvic adhesions

81. Other Causes in Women
Medications
Thyroid problems
Cancer and its treatment.
Other medical conditions
Caffeine intake

82. Risk Factors
 Age
 Tobacco smoking
 Alcohol use
 Being overweight
 Being underweight
 Too much exercise
 Caffeine intake

83. Tests and Diagnosis
Tests for men
General physical examination
Semen analysis
Hormone testing
Transrectal and scrotal ultrasound

84. Tests for women
 Ovulation testing
 Hysterosalpingography
 Laparoscopy
 Hormone testing
 Ovarian reserve testing
 Genetic testing
 Pelvic ultrasound

85. Treatments and Drugs
Treatment for couples
 Increase frequency of intercourse
Treatment for men
 General sexual problems
 Lack of sperm
Treatment for women
 Clomiphene (Clomid, Serophene).
 Human menopausal gonadotropin, or hMG,
(Repronex).

86.  Follicle-stimulating hormone, or FSH, (Gonal-F,
Bravelle
 Human chorionic gonadotropin, or HCG,
(Ovidrel, Pregnyl).
 Gonadotropin-releasing hormone (Gn-RH)
analogs.
 Aromatase inhibitors
 Metformin (Glucophage).
 Bromocriptine (Parlodel).

87.  Surgery
 Assisted reproductive technology (ART)
 The most common forms of ART include
In vitro fertilization (IVF).
Electric or vibratory stimulation to achieve
ejaculation.
Surgical sperm aspiration
Intracytoplasmic sperm injection (ICSI
Assisted hatching

88. Complications of Treatment
Multiple pregnancy
Ovarian hyperstimulation
syndrome (OHSS).
Bleeding or infection
Low birth weight
Birth defects

89. Coping and Support
 Planning for emotional turmoil
Set limits
Consider other options
Talk about your feelings

90.  Managing emotional stress during treatment
Acupuncture
Practice relaxation.
Express yourself
Stay in touch with loved ones

91.  Managing emotional effects of the outcome
Failure
Success
Multiple births

92. Prevention
Exercise moderately
Avoid weight extremes
Avoid alcohol, tobacco and
street drugs
Limit caffeine
Limit medications

93. Varicocele

94. Definition
An enlargement of the
veins within the scrotum,
the loose bag of skin that
holds your testicles.

95. Abnormal dilation (varicosity) of
the pampiniform plexus of veins
that drains the testes.

97. Symptoms
Often produces no symptoms.
Rarely, it may cause pain that
may worsen over the course of a
day.

98. Incidence
More common on the left side.
Varicocele on the right side- sign of
obstruction caused by a tumor
Palpable in 10% of men in general
population
Palpable in 30% of men with infertility

99. Risk Factors
You're at greater risk
of varicoceles
between the ages of
15 and 25.

100. Tests and Diagnosis
Physical Exam
Scrotal Ultrasound

101. Complications
Shrinkage of the affected
testicle (atrophy).
Infertility

102. Treatment
Open surgery
Laparoscopic surgery
Percutaneous embolization

103. Lifestyle and Home Remedies
Take over-the-counter
painkillers
Wear an athletic supporter to
relieve pressure

104. Breast Cancer

106. Description
Cancer originating in the breast
1.The leading cancer in women.
2. 1 in 8 women will develop cancer
3. Early detection
4. Men--- 1% reported cases
5. 90-95%- discovered through BSE

107. Risk Factors
 Positive Family History
 Menarche before 12 years of age or
menopause after age 50.
 Nulliparous, or 1st child after age 30
 History of uterine cancer
 Daily alcohol intake
 Highest incidence--- 40-49 and over 65

108. NOTE:
Breast cancer is generally
adenocarcinoma, originating in
epithelial cells and occurs in the
ducts and lobes.
Tumors tend to be located in the
outer quadrant of the breast than
the right.

109.  Tumors less than 4 cm. are deemed curable.
 Larger tumor require much more aggressive
treatment.
 Common sites of metastasis :
a. Axillary
b. Supraclavicular
c. Mediastinal lymph nodes
d. Lungs, liver, brain and spine
 Bone metastasis is extremely painful

110. Symptoms
 Firm, nontender, nonmobile mass
 Solitary, irregularly shaped mass
 Dimpling of skin
 Retraction of nipple
 Alterations in contour of breast
 Change in skin color
 “Orange peel” skin
 Discharge from nipple
 Pain and ulcerations ( late signs)

112. Cancer Development
Cancer begins as a
cluster of abnormal
cells. Over time, the
abnormal cells continue
to change in appearance
and multiply, evolving
into noninvasive (in
situ) cancer or,
eventually, invasive
cancer. Invasive cancer
can spread to other areas
of the body through the
bloodstream or the
lymphatic system.

113. Stages of Breast Cancer
 Stage I. Tumor size is up to 2cm.
 Stage II. Tumor size is up to 5cm.,With
axillary lymph node involvement.
 Stage III. Tumor size is more than 5 cm.,
with axillary and neck lymph nodes
involvement.
 Stage IV. Metastasis to distant organs (liver,
lungs, bone and brain)

114. Inflammatory
breast cancer
often appears as
an enlarged
breast with red,
thickened skin.

116. Diagnostic Test
Mammogram- helpful with every
early detection of cancer of the
breast.
1. Baseline mammogram – 35-50 years
of age.
2. Every 1 to 2 years- above 40

117. 3. Annually- Above 40 years old
4. No use of lotions, talc powder, or
deodorant underarms ( may mimic
calcium deposits on x-ray)

118. Biopsy- for definitive diagnosis
of cancer
Physical Examination by a
professional skilled examination
of the breast should be done
annually.

119. Sentinel Node Biopsy
To determine whether
cancer has spread to the
nearby lymph nodes,
doctors may use a
sentinel node biopsy.
Doctors determine
which lymph node is
likely to be the first stop
for spreading cancer
cells by injecting a
harmless dye or a weak
radioactive solution near
the tumor. That sentinel
lymph node is removed
and tested for cancer
cells.

120. Treatment
Lumpectomy
The surgeon makes an
incision large enough
to remove the tumor
and a margin of
healthy tissue
surrounding the
tumor. The rest of your
breast remains intact.

121.  A simple or total
mastectomy (left) removes
the breast tissue, nipple,
areola and skin, but not all
the lymph nodes. A
modified radical
mastectomy (right)
removes the entire breast,
including the breast tissue,
skin, areola and nipple,
and most of the underarm
(axillary) lymph nodes.

122. Modified Radical Mastectomy

123.  Radical Mastectomy (Halstead Surgery)
- Involves removal of the entire
breast, pectoralis major and minor
muscles. Axillary and neck lymph
nodes. It is followed by skin
grafting.

124. CHEMOTHERAPY- uses drugs to destroy cancer
cells
adjuvant systemic chemotherapy- chemotherapy
after surgery to decrease the chance that the cancer
will recur
neoadjuvant chemotherapy- given before surgery
Side effects:
hair loss, nausea, vomiting, fever and frequent
infections.

125. Radiation Therapy
External beam radiation
uses high-powered
beams to kill cancer
cells. Beams of
radiation are precisely
aimed at the breast
cancer using a machine
that moves around
your body.

126. Preoperative Care
Psychosocial support. Include the
husband.
Explore client’s expectations of surgery
and what the surgical site will look like
post-op.
Discuss skin graft if one possible and
cosmetic reconstruction that might be
implemented with mastectomy.

127. Post Operative Care
 Monitor bleeding, check under dressing, HemoVac,
and under client’s back. ( bleeding will run to back)
 Position arm on operative side on a pillow, slightly
elevated.
 Avoid BP measurements, injections, and venipuncture
in affected arm.
 Instruct client to avoid injury such as burns or scrapes
to affected arm.

128.  Encourage hand activity by squeezing a small rubber
ball.
 Encourage client to perform activities that will use
arm, like brushing hair.
 Teach post-mastectomy exercises (wall climbing with
affected arm and rope turning).
 Encourage client to verbalize concerns:
A. Cancer B. Death C. Loss of breast
 Information about breast prosthesis.

129. Fibrocystic disease of the
breast

130.  Fibrocystic breast
disease is a common and
benign change within
the breast characterized
by a dense irregular and
bumpy consistency in
the breast tissue.
Mammography or biopsy
may be needed to rule
out other disorders.

131. Definition
 composed of tissue that feels ropy, lumpy or
bumpy in texture. Doctors call this
"nodular" or "glandular" breast tissue.
 more than half of women experience
fibrocystic breast changes
 "fibrocystic breasts" or "fibrocystic breast
changes“
 occur most often in women in their 20s to
50s

132. Symptoms
Breast lumps or areas of thickening
Breast pain or tenderness
Fluctuating size of breast lumps
Nonbloody nipple discharge, in some cases
Changes in both breasts, usually
Monthly increase in breast pain or
lumpiness from midcycle (ovulation) to
just before your period .

133. Causes
 Unknown
 experts suspect that reproductive hormones —
especially estrogen — play a role.
 When examined under a microscope, fibrocystic
breast tissue includes distinct components such as:
a. Fluid-filled round or oval sacs (cysts)
b. A prominence of scar-like fibrous tissue (fibrosis)
c. Overgrowth of cells (hyperplasia) lining the milk
ducts or milk-producing tissues (lobules) of the breast
d. Enlarged breast lobules (adenosis)

134. Tests and Diagnosis
Clinical breast exam and
physical exam
Mammography
Ultrasound
Breast biopsy

135. Treatments and Drugs
 Fine-needle aspiration. Your doctor uses a hair-thin
needle to drain the fluid from the cyst. Removing fluid
confirms that the lump is a breast cyst and, in effect,
removes it, relieving associated discomfort.
 Surgical excision. Rarely, surgery may be needed to
remove a persistent cyst-like lump that doesn't resolve
after repeated aspiration and careful monitoring.