CHAPTER 50 • A small, erectile organ made of shaft and

glans (tip), located beneath the pubic arch.

External Genitalia (Vulva)
• It is highly sensitive due to a dense
The external genitalia are collectively known
concentration of nerve endings, making it
as the vulva, which includes multiple
the primary structure for sexual arousal and
structures with different functions:
pleasure in females.
Mons Pubis
• The clitoris secretes smegma, which
• A thick pad of adipose (fat) tissue that sits contains pheromones that may contribute to
above the symphysis pubis (the joint sexual attraction.
between the two pubic bones).
Urinary Meatus (Urethral Opening)
• Acts as a cushion during penile-vaginal
• Located below the clitoris, this is the
intercourse to protect the underlying pubic
external opening of the urethra, through
bone.
which urine exits the body.
Labia Majora (“Large Lips”)
• It appears as a slit-like structure and is
• Two thick folds of connective tissue separate from the vaginal opening.
covered with pubic hair that extend from the
Introitus (Vaginal Opening)
mons pubis to the perineum (the area
between the vagina and anus). • Located below the urinary meatus, the
introitus serves as the entry to the vagina.
• Their function is to protect the more
delicate structures inside, including the labia • It is partially covered by the hymen, a thin
minora, clitoris, urethral opening, and vaginal membrane that varies in size and shape
opening. among women.

Labia Minora (“Small Lips”) • The size or presence of the hymen is not a
reliable indicator of sexual experience since it
• Two narrow, hairless folds of skin located
can be stretched by non-sexual activities
within the labia majora.
such as exercise or tampon use.
• These folds are highly vascular (rich in
Bartholin’s Glands
blood supply) and innervated (rich in nerve
endings), making them very sensitive to • These paired glands are located on either
touch and temperature. side of the vaginal opening within the labia
minora.
• The prepuce (clitoral hood) is formed where
the labia minora meet at the top. • They secrete mucus through tiny ducts,
helping to lubricate the vagina during sexual
• The labia minora help with lubrication and
arousal.
protect the vaginal opening.

Clitoris
• Infections of these glands can lead to Function of the Levator Ani Muscles
Bartholin’s cysts or abscesses, which can be
• Support pelvic organs under pressure from
painful.
activities like coughing, sneezing, and lifting.
Skene’s Glands
• Prevent urinary incontinence and pelvic
• Located near the urethral opening, these organ prolapse.
glands also secrete mucus, helping with
• Contract during orgasm to enhance
lubrication and possibly contributing to
sensation.
female ejaculation.
Other Supporting Muscles
Fourchette and Perineum
Bulbocavernosus:
• The fourchette is the thin band of skin
where the labia minora meet below the  Surrounds the vagina and urethra;
vaginal opening. contracts during orgasm and helps
control urination.
• The perineum is the muscular area
between the vagina and anus, which Ischiocavernosus:
supports pelvic floor muscles.
 Helps maintain clitoral erection by
Muscular Support of the External Genitalia increasing blood flow.
Several muscle groups support the pelvic
Transverse Perineal Muscles:
organs and maintain continence (control
over urination and defecation). These  Support the perineum and help
muscles are essential for sexual function, maintain the stability of external
childbirth, and bladder control. genitalia.

Levator Ani Muscle Group (Pelvic Floor The internal female reproductive
Muscles)
Vagina
• This deep muscle layer forms the pelvic
The vagina is a muscular, tubular canal (7.5–
diaphragm, which acts like a hammock to
10 cm long) lined with a glandular mucous
support the uterus, vagina, bladder, and
membrane. It extends from the vulva
rectum.
(external opening) to the cervix (lower part of
• It is composed of three muscles: the uterus).

1. Iliococcygeus – Helps maintain pelvic Functions:

organ support.
Serves as the passage for menstrual
2. Pubococcygeus – Provides elasticity and flow.
control over urination and defecation. Acts as the birth canal during
childbirth.
3. Puborectalis – Assists with continence,
Accommodates the penis during
controlling bowel movements by
intercourse.
maintaining rectal closure.
 Its fornix (upper part) surrounds the blocking sperm entry depending on the
cervix, allowing sperm to enter the menstrual cycle.
uterus.
• The vaginal surface of the cervix is a
The vagina has little sensation due to
common site for cervical cancer due to rapid
low nerve supply, but it is highly
cell growth.
vascular and can expand during
childbirth. Uterine Wall Layers

Uterus The uterus has three layers that work

together for menstruation, pregnancy, and
The uterus is a pear-shaped muscular organ
childbirth:
(7.5 cm long, 5 cm wide) located in the pelvic
cavity. It is held in place by ligaments, 1. Endometrium (Inner Layer)
including the round ligaments, broad
• Function: Thickens in response to
ligaments, and uterosacral ligaments. The
hormones to prepare for pregnancy.
uterus varies in size depending on pregnancy
history (nulliparous women have a smaller • If fertilization does not occur, it sheds
uterus than multiparous women). during menstruation.

Four Parts of the Uterus: 2. Myometrium (Middle Muscle Layer)

• Fundus: The upper rounded part above the • Function: Contracts during childbirth to
fallopian tubes. expel the baby.

• Corpus (Body): The main portion between • Composed of three muscle layers:
the fundus and isthmus.
• Outer Layer: Longitudinal fibers in the
• Isthmus: The lower uterine segment that fundus provide power for contractions.
connects the body to the cervix, important
• Middle Layer: Figure-eight muscle pattern
during pregnancy.
contracts after childbirth to control blood
• Cervix: The lower part that connects to the loss.
vagina, allowing menstrual flow and sperm
• Inner Layer: Circular fibers around the cervix
entry.
help keep it closed during pregnancy.
Cervix Anatomy & Function:
3. Perimetrium (Outer Layer)
• The external os is the vaginal opening of the
• Function: Protects the uterus and connects
cervix, which changes shape after childbirth
it to other pelvic structures.
(round before first birth, slit-like after).
Fallopian Tubes (Oviducts)
• The internal os connects the cervix to the
uterus. The fallopian tubes (10 cm long) extend from
the uterus and curve around the ovaries,
• The cervix produces mucus, which plays a
serving as a passageway for eggs. They are
crucial role in fertility by either facilitating or
internally continuous with the uterine cavity, Female Reproductive System’s Function
ensuring smooth transport of the egg.
The female reproductive system functions
Four Parts of the Fallopian Tube: primarily through ovulation and the
menstrual cycle, which are regulated by
• Infundibulum: The funnel-shaped end,
hormones from the ovaries, pituitary gland,
covered with fimbriae, which create wavelike
and hypothalamus. These processes prepare
motions to pull the egg inside.
the body for potential pregnancy and are
• Ampulla: The widest section where driven by a balance of estrogen,
fertilization usually occurs. progesterone, follicle-stimulating hormone
(FSH), and luteinizing hormone (LH).
• Isthmus: A narrow section that connects to
the uterus.

• Interstitial Portion: The smallest part, which 1.Ovulation

opens into the uterine cavity. Function of
Ovulation is the release of a mature egg
Fallopian Tubes:
(ovum) from the ovary, usually occurring
Transports mature eggs from the ovaries about two weeks before the next menstrual
to the uterus. period. This process begins at puberty (ages
11–13) and continues until menopause.
Provides the site for fertilization.
How Ovulation Works:
Nourishes the fertilized egg before it
reaches the uterus. 1. Ovum Maturation:

Ovaries • The ovary produces an immature egg

(oocyte), which grows inside a Graafian
The ovaries are almond-shaped structures (3
follicle.
cm long) located behind the broad
ligaments, near the fallopian tubes. Functions • The follicle enlarges and moves to the
of the Ovaries: surface of the ovary.

Produce eggs (ova)—each ovary contains 2. Egg Release (Ovulation):

thousands of immature eggs at birth.
• When the follicle ruptures, the mature egg
Secrete hormones (estrogen and is released into the peritoneal cavity.
progesterone), which regulate the menstrual
• The fimbriae of the fallopian tube help
cycle and pregnancy.
guide the egg into the tube, where it travels
Work with the fallopian tubes to support toward the uterus.
fertilization and early embryonic
3. Fertilization or Disintegration:
development. The ovaries and fallopian
tubes together are called the adnexa, • If the egg meets a sperm, fertilization
meaning the structures attached to the occurs, forming a zygote that implants in the
uterus. uterus.
• If no fertilization occurs, the egg C. Secretory (Luteal) Phase (Days 15–28)
disintegrates within 24 hours.
• The corpus luteum secretes progesterone,
4. Corpus Luteum Formation: maintaining the thick uterine lining.

• After ovulation, the ruptured follicle turns • If fertilization occurs, the zygote implants in
into the corpus luteum, which secretes the uterus, and pregnancy begins.
progesterone.
• If no fertilization occurs, estrogen and
• Progesterone prepares the uterus to progesterone levels drop, leading to the next
receive a fertilized egg by thickening the phase.
uterine lining.
D. Menstrual Phase (Days 1–5 of Next Cycle)
• If no pregnancy occurs, the corpus luteum
• The uterine lining sheds, resulting in
shrinks, and progesterone levels drop,
menstrual bleeding (menses), which consists
leading to menstruation.
of old blood, mucus, and tissue.
2. The Menstrual Cycle
• FSH rises again, stimulating new follicle
The menstrual cycle is a 28-day hormonal growth, and the cycle repeats.
cycle that prepares the uterus for pregnancy.
3. Hormones Regulating the Cycle Hormone
However, normal variations range from 21 to
Function
42 days.
Follicle-Stimulating Hormone (FSH) -
It consists of four phases:
Stimulates the growth of ovarian follicles and
A. Proliferative Phase (Days 1–14) estrogen production.

• Starts after menstruation ends. Luteinizing Hormone (LH)

• FSH (Follicle-Stimulating Hormone) is -Triggers ovulation and stimulates

released by the pituitary gland, stimulating progesterone production.
ovarian follicles to grow and produce
Estrogen
estrogen.
-Thickens the uterine lining and regulates
• Estrogen causes the endometrium (uterine
female reproductive organs.
lining) to thicken and become more vascular,
preparing for potential implantation. Progesterone

B. Ovulation (Around Day 14) Prepares the uterus for pregnancy;

maintains pregnancy if fertilization occurs.
• A spike in Luteinizing Hormone (LH)
triggers ovulation. Gonadotropin-Releasing Hormone (GnRH) -
Controls FSH and LH release from the
• The mature egg is released from the ovary
pituitary gland.
and enters the fallopian tube.
Hormonal Feedback Mechanism:
• This is the most fertile period in the cycle.
 • High estrogen levels → Suppress FSH, B. Menopause (Final Menstrual Period)
stimulate LH surge (triggers ovulation).
• Officially diagnosed when a woman has no
• High progesterone levels → Suppress LH, menstruation for 12 consecutive months.
prevent further ovulation.
• Ovaries stop releasing eggs and no longer
• Low estrogen/progesterone levels → produce estrogen and progesterone.
Trigger FSH release, starting a new cycle.
• Can occur naturally or be induced by
Summary of the Female Reproductive surgery (ovary removal) or treatments like
System’s Function: chemotherapy.

Ovulation releases a mature egg. C. Postmenopause (After Menopause)

The menstrual cycle prepares the uterus • The body adjusts to lower hormone levels.
for pregnancy.
• Increased risk of conditions like
Hormones regulate ovulation, fertilization, osteoporosis and cardiovascular disease.
and menstruation.
2. Effects of Menopause
If pregnancy occurs, hormonal changes
A. Reproductive Changes
support fetal development.
Ovarian inactivity → No more ovulation or
If no pregnancy occurs, hormone levels
menstrual cycles.
drop, and menstruation begins.
Reproductive organs shrink (uterus,
Menopausal Period
vagina, ovaries).
Menopause marks the end of a woman’s
Vaginal dryness due to decreased
reproductive years and typically occurs
estrogen.
between 41 and 59 years of age. It is a natural
biological process where ovarian function B. Hormonal Changes
declines, leading to the cessation of
Estrogen and progesterone decline →
menstruation and hormone production.
Affects many body systems.
1. Stages of Menopause
Increased levels of FSH and LH (as the
A. Perimenopause (Transition Phase) body tries to stimulate the ovaries).

• Begins as early as age 35 and lasts until C. Physical and Emotional Symptoms
menopause.
Hot flashes (sudden heat sensation,
• Ovarian function declines, causing irregular sweating).
menstrual cycles.
Mood swings, irritability, anxiety, or
• Hormonal fluctuations lead to physical and depression.
emotional symptoms.
 Sleep disturbances (insomnia, night discomfort, irregularities, or excessive
sweats). bleeding.

Weight gain and slowed metabolism. Types of Menstrual Disorders

Bone loss (risk of osteoporosis increases). Premenstrual Syndrome (PMS)

Higher risk of cardiovascular disease due – A group of physical, emotional, and

to lower estrogen. behavioral symptoms before menstruation.

3. Health Promotion During Menopause Dysmenorrhea – Painful menstruation

(cramps).
Hormone Replacement Therapy (HRT) –
Helps manage severe symptoms but has Amenorrhea – Absence of menstruation.
risks. Menorrhagia – Excessive or prolonged
Calcium and Vitamin D supplements – bleeding.
Prevents bone loss. Metrorrhagia – Irregular or non-cyclic
Regular exercise – Supports heart and bleeding.
bone health. Premenstrual Syndrome (PMS)
Healthy diet – Reduces weight gain and A. Causes of PMS
improves metabolism.
• Exact cause unknown but linked to
Mental health support – Manages mood hormonal fluctuations.
swings and emotional changes.
• Other contributing factors: stress, diet, lack
Summary of Menopause: of exercise.
Marks the end of reproduction (no more B. Symptoms of PMS Physical Symptoms
ovulation, menstruation, or ovarian
hormones). Fluid retention (bloating, breast
tenderness).
Causes physical, emotional, and metabolic
changes due to declining estrogen. Headaches, fatigue, back pain. Affective
(Emotional) Symptoms
Increases risks of osteoporosis and
Mood swings, anxiety, depression,
cardiovascular disease.
irritability.
Lifestyle changes, HRT, and medical care
Crying spells, anger, confusion.
can help manage symptoms.
Social withdrawal and difficulty
Menstrual Disorders:
concentrating.
Menstrual disorders are conditions that
C. Timing of Symptoms
affect the normal menstrual cycle, leading to
• Appear 5 days before menstruation.
• Relief occurs within 4 days after Encourage Social Support – Partner,
menstruation begins. family, and friends can help.

• Symptoms may disrupt work, relationships, Provide PMS Support Services –

and daily life. Counseling for emotional distress.

Premenstrual Dysphoric Disorder (PMDD) Assess for Suicidal or Violent Behavior –

Immediate psychiatric evaluation if
• Severe form of PMS with intense emotional
necessary.
and physical symptoms.
Summary of PMS and Menstrual Disorders:
• Can significantly affect daily life and may
require medical treatment. PMS is a common condition affecting
physical and emotional well-being.
Treatment and Management of PMS/PMDD
PMDD is a severe form that significantly
A. Lifestyle and Home Remedies
impacts daily life.
Healthy Diet – Whole grains, fruits,
Lifestyle changes, medication, and stress
vegetables; avoid high-fat foods, refined
management can help.
sugars, caffeine, and alcohol.
Severe cases may require medical or
Regular Exercise – Helps with mood
psychological intervention.
stability and physical discomfort.
Dysmenorrhea (Painful Menstruation)
Stress Management – Meditation, yoga,
and creative activities. Dysmenorrhea refers to painful menstruation
and can be primary or secondary, depending
B. Medical Management Medications Used
on the underlying cause.
Selective Serotonin Reuptake Inhibitors
1. Types of Dysmenorrhea
(SSRIs) – e.g., fluoxetine (for mood stability).
A. Primary Dysmenorrhea
Diuretics (e.g., spironolactone) – Reduce
bloating and fluid retention. Painful periods without any identifiable
pelvic disease.
Pain relievers (e.g., ibuprofen, naproxen) –
Manage headaches and cramps. Usually starts soon after menarche (first
period).
Oral Contraceptives (e.g., drospirenone-
containing pills) – Regulate hormones. Caused by excess prostaglandins, leading
to strong uterine contractions.
Anti-anxiety medications – Used in severe
cases. Symptoms:

C. Nursing and Psychological Support • Cramping pain before or during

menstruation.
Track Symptoms – Keeping a symptom
journal helps anticipate PMS patterns. • Pain lasts 48 to 72 hours.
 • May include nausea, diarrhea, dizziness, Taken before cramps begin for best results.
and backache.
Oral Contraceptives (Birth Control Pills) –
Pelvic examination findings are normal. Regulate hormones and reduce pain.

B. Secondary Dysmenorrhea Heat Therapy – Heating pads or warm

baths help relax muscles.
Painful periods caused by an underlying
condition. Exercise & Physical Activity – Improves
blood circulation and reduces cramps.
Can occur before, during, or after
menstruation. Stress Management – Relaxation
techniques such as yoga and meditation.
Associated with:
B. Secondary Dysmenorrhea Treatment
• Endometriosis (tissue similar to the uterine
lining grows outside the uterus). Identify and treat the underlying cause
(e.g., endometriosis, PID, fibroids).
• Pelvic inflammatory disease (PID).
Hormonal therapy (birth control pills,
• Fibroids, polyps, or malignancies.
GnRH agonists) to control conditions like
Symptoms may also occur during endometriosis.
ovulation or sexual intercourse.
Surgery (in severe cases) – If fibroids, cysts,
2. Diagnosis of Dysmenorrhea or endometriosis need removal.

Pelvic Examination – To check for physical Amenorrhea

abnormalities.
(Absence of Menstruation) Amenorrhea is
Ultrasound or MRI – To detect fibroids, the absence of menstrual periods and can be
endometriosis, or other structural causes. classified as primary or secondary.

Laparoscopy – A small camera inserted 1. Types of Amenorrhea

into the abdomen to diagnose endometriosis
A. Primary Amenorrhea
or other pelvic conditions.
No menstruation by age 15, with no
3. Treatment & Management of
secondary sexual characteristics.
Dysmenorrhea
No menstruation by age 16, despite
A. Primary Dysmenorrhea Treatment
normal puberty.
NSAIDs (Nonsteroidal Anti-Inflammatory
Causes:
Drugs) – Reduce prostaglandins and relieve
pain. • Genetic disorders (e.g., Turner syndrome). •
Anatomical abnormalities (e.g., imperforate
Examples: • Ibuprofen, Naproxen, Mefenamic
hymen, Mullerian agenesis).
Acid, Aspirin. •
• Hormonal imbalances (e.g., thyroid or Hormone therapy – Estrogen and
pituitary disorders). progesterone supplements for hormonal
imbalances.
• Nutritional deficiencies (e.g., anorexia
nervosa, extreme weight loss). Medications –

B. Secondary Amenorrhea • Clomiphene citrate (for ovulation induction

in PCOS).
Absence of menstruation for 3 cycles or 6
months after normal menarche. • Thyroid medications (for hypothyroidism).

Causes: Key Takeaways

• Pregnancy (most common cause). • Dysmenorrhea = Painful periods, caused

Breastfeeding or menopause. by prostaglandins (primary) or underlying
disease (secondary).
• Polycystic ovarian syndrome (PCOS).
Amenorrhea = Absent periods, caused by
• Extreme weight loss or eating disorders
hormonal, genetic, or lifestyle factors.
(anorexia, bulimia).
NSAIDs, birth control, and lifestyle
• Excessive exercise (common in athletes).
changes help treat dysmenorrhea.
• Thyroid disorders or hormonal imbalances.
Amenorrhea treatment depends on the
2. Diagnosis of Amenorrhea cause – lifestyle changes, hormone therapy,
or medication.
Physical and pelvic examination.
Abnormal Uterine Bleeding (AUB)
Blood tests – Check for pregnancy, thyroid
function, and hormone levels. Abnormal uterine bleeding refers to
irregular, excessive, prolonged, or
Ultrasound or MRI – Detects anatomical
unpredictable menstrual bleeding. It can
abnormalities.
occur at any age but is most common in
Genetic testing – If Turner syndrome or adolescents and perimenopausal women
chromosomal disorders are suspected. due to hormonal fluctuations.

3. Treatment & Management of Amenorrhea 1. Causes of Abnormal Uterine Bleeding

Address the underlying cause (e.g., Anovulation (lack of ovulation) – Common

hormonal therapy for PCOS, weight in adolescents (immature hormonal system)
management for eating disorders). and perimenopausal women (declining
ovarian function).
Lifestyle changes – Balanced diet, stress
reduction, and moderate exercise. Hormonal imbalances – Irregular estrogen
and progesterone levels.

Fibroids or polyps – Noncancerous

growths in the uterus.
 Obesity – Increased estrogen levels from • Procedures: Endometrial ablation (removes
excess fat tissue. uterine lining) or hysterectomy (removes
uterus) in severe cases.
Hypothalamic dysfunction – Disrupts
hormone regulation. B. Metrorrhagia (Bleeding between periods)

Bleeding disorders – Low platelet count, Unscheduled vaginal bleeding between

clotting issues. menstrual cycles.

Medications – Anticoagulants, hormonal Causes:

therapy.
• Hormonal imbalances.
Cancer – Endometrial or cervical cancer
• Fibroids, polyps, or tumors.
may cause unusual bleeding. Important: Any
abnormal or unusual bleeding should be • Infections or STIs.
evaluated to rule out serious conditions.
• Cervical or endometrial cancer.
2. Types of Abnormal Uterine Bleeding
Evaluation: • Essential to rule out serious
A. Menorrhagia (Heavy or prolonged conditions like cancer.
menstrual bleeding)
Treatment:
Excessive bleeding during regular
• Depends on the cause (e.g., hormone
menstrual cycles.
therapy, removal of fibroids, infection
Causes: treatment).

• Hormonal imbalances (common in young C. Menometrorrhagia (Heavy & irregular

and perimenopausal women). bleeding)

• Fibroids, polyps, or tumors. Heavy bleeding that occurs both during

and between periods.
• Bleeding disorders or anticoagulant use.
Requires urgent medical evaluation to
Complications:
determine the cause.
• Can lead to anemia (low red blood cells).
Dyspareunia (Painful Sexual Intercourse)
Evaluation:
Dyspareunia refers to pain or discomfort
• Track bleeding with pad count (e.g., soaking during or after penile-vaginal intercourse. It
a pad/tampon every hour). can be superficial (external), deep (internal),
primary (lifelong), or secondary (developed
Treatment:
later in life).
• Medications: NSAIDs, hormonal therapy,
1. Causes of Dyspareunia
tranexamic acid (reduces bleeding).
Physical Causes:
• Vaginal dryness (due to menopause, • Surgery (if severe).
breastfeeding, medications).
For Psychological Causes:
• Childbirth injuries (episiotomy scars,
• Counseling & therapy (for trauma, anxiety,
perineal trauma).
or relationship concerns).
• Infections (UTIs, STIs, pelvic inflammatory
• Pelvic floor therapy (to relax tense muscles).
disease).
Key Takeaways
• Endometriosis (tissue growth outside the
uterus). AUB (Abnormal Uterine Bleeding) can
result from hormonal imbalances, fibroids,
• Fibroids or ovarian cysts.
medications, or serious conditions like
Psychological Causes: cancer.

• History of sexual trauma, assault, or abuse. Menorrhagia (heavy periods) can lead to
anemia and may require hormonal therapy
• Anxiety, depression, or relationship issues.
or surgery.
2. Diagnosis & Evaluation
Metrorrhagia (bleeding between periods)
Pelvic exam – To check for infections, needs urgent evaluation to rule out cancer or
scarring, or anatomical issues. tumors.

Ultrasound or MRI – If deep pain suggests Dyspareunia (painful intercourse) may

endometriosis or fibroids. have physical, hormonal, or psychological
causes, requiring a comprehensive
Psychological assessment – If past trauma
evaluation and treatment plan.
is a factor.
Contraception
3. Treatment of Dyspareunia
helps prevent unintended pregnancies,
For Vaginal Dryness:
offering various methods to suit individual
• Lubricants & moisturizers (water-based or needs, preferences, and medical conditions.
silicone-based). Family planning benefits women, newborns,
and communities, reducing health risks and
• Hormonal therapy (topical estrogen
financial burdens.
creams for menopausal women).
1. Factors in Choosing a Contraceptive
For Infection or Inflammation:
Method
• Antibiotics, antifungals, or antiviral
Effectiveness – Failure rates vary among
medications for UTIs, STIs, or pelvic infections
methods.
For Endometriosis or Fibroids:
Health Conditions – Some conditions (e.g.,
• Hormonal therapy (birth control, GnRH blood clots, liver disease) may limit options.
agonists).
 Lifestyle & Preferences – Daily, long-term, • Small risk of uterine perforation or
or permanent options. infection.

Side Effects & Risks – Hormonal vs. non- • Risk of pregnancy complications if
hormonal considerations. conception occurs with IUD in place.

Protection from STIs – Only barrier 2. Contraceptive Implant (Effective for 3 years)
methods (e.g., condoms) provide STI
A single-rod implant inserted under the
protection.
skin of the upper arm.
2. Contraceptive Methods
Releases progestin to prevent ovulation.
A. Abstinence (100% effective) Advantages:

Prevents pregnancy and STIs. • Highly effective and low maintenance.

Not always a practical choice due to • Safe for lactating women.

personal or cultural factors.
Disadvantages:
B. Long-Acting Reversible Contraceptives
• Irregular bleeding or amenorrhea (no
(LARCs) (Highly effective, <1% failure rate)
periods).
1. Intrauterine Devices (IUDs)
• Requires minor procedure for insertion and
T-shaped device inserted into the uterus. removal.
Types:
C. Permanent Sterilization (Irreversible)
• Hormonal IUD (3-5 years) – Releases
For individuals certain they do not want
progestin to prevent ovulation and thicken
future pregnancies.
cervical mucus.
Female sterilization: Tubal ligation –
• Non-hormonal IUD (10 years) – Uses
Fallopian tubes are cut, tied, or sealed.
copper to create a hostile environment for
sperm. Male sterilization: Vasectomy – The vas
deferens is cut to block sperm transport.
Advantages:
D. Hormonal Contraceptives
• Long-lasting, no daily maintenance.
1. Oral Contraceptives (“The Pill”)
• Few systemic effects.
Combination pills (estrogen + progestin) –
• Reversible (fertility returns quickly after
Prevent ovulation, thicken cervical mucus.
removal).
Progestin-only pills (“mini-pill”) – Suitable
Disadvantages:
for breastfeeding women or those at risk for
• Cramps, heavy bleeding (especially with blood clots.
copper IUDs).
Benefits:
• Regulates cycles, reduces cramps, 4. Injectable Contraceptives (Depo-Provera)
decreases anemia risk.
An intramuscular injection of progestin
• Lowers risk of ovarian and uterine cancer. given every 13 weeks.

Risks: Advantages:

• May cause nausea, mood changes, weight • Highly effective and private.
gain.
• Reduces heavy periods, menstrual pain, and
• Small increased risk of blood clots, stroke, anemia.
heart attack (higher in smokers).
Disadvantages:
2. Transdermal Patch
• Irregular bleeding, bloating, weight gain,
A small skin patch releases hormones into decreased libido.
the bloodstream.
• May cause bone mineral loss with long-
Applied weekly for 3 weeks, then a 1-week term use (use should be limited to 2 years).
break.
Key Takeaways
Disadvantages:
LARCs (IUDs & implants) are the most
• Not effective for women over 198 lbs (90 effective reversible options.
kg).
Permanent sterilization is for those certain
• May cause skin irritation, increased clotting they do not want future pregnancies.
risk.
Hormonal methods (pills, patches, rings,
3. Vaginal Ring injections) regulate cycles but may have side
effects.
A flexible ring inserted into the vagina for
3 weeks. Barrier methods (e.g., condoms) are the
only ones that protect against STIs.
Slowly releases estrogen and progestin.
Contraceptive choice should be based on
Advantages:
medical history, lifestyle, and personal
• Lower hormone dose than oral preference.
contraceptives.
1. Mechanical Barriers
• No need for daily pills.
Mechanical barrier methods work by
Disadvantages: preventing sperm from reaching the egg.
These methods include:
• May cause vaginal discomfort or be
noticeable to a partner. Diaphragm:

• Higher cost than oral contraceptives. • A flexible latex cup that covers the cervix
and is used with spermicide.
• Must be fitted by a healthcare provider. • Involves pulling out before ejaculation.

• Should be checked for damage before use • Unreliable because pre-ejaculatory fluid
and must stay in place for at least 6 hours may still contain sperm.
after sex.
2. Fertility Awareness-Based Methods
• Risks include latex allergies, urinary tract (Natural Family Planning)
infections, and rarely, toxic shock syndrome.
These methods involve tracking the woman’s
Cervical Cap: menstrual cycle to determine when she is
most fertile and avoiding sex (or using
• Smaller than a diaphragm, it only covers the
protection) during that time.
cervix.
Standard Days Method:
• Can be left in place for up to 2 days.
• Avoids unprotected sex on days 8 to 19 of
• May cause cervical irritation and requires a
the menstrual cycle.
Pap smear before and after use.
• Works best for women with regular cycles.
Female Condom:
• Can be difficult to follow and requires
• A polyurethane pouch that lines the vagina
discipline.
and protects against STIs and pregnancy.
Ovulation Detection Kits:
• More expensive than male condoms and
may not work well in certain sexual positions. • Over-the-counter tests that detect
ovulation through hormone changes in
• Spermicides:
cervical mucus.
• Chemicals (like nonoxynol-9) available as
• More effective for conception than for
foams, gels, films, or sponges.
contraception.
• Do not protect against STIs and must be
3. Emergency Contraception
used before each sexual encounter.
These methods are used after unprotected
• Male Condom:
sex to prevent pregnancy.
• A latex or polyurethane sheath worn over
• Emergency Contraceptive Pills (Morning-
the penis to prevent sperm from entering the
After Pill):
vagina.
• Must be taken within 5 days of unprotected
• Helps prevent STIs, but natural condoms
sex.
(made from animal tissue) do not protect
against HIV. • Works by delaying ovulation.

• Latex allergy can be an issue for some • May cause side effects like nausea, irregular
people. bleeding, and breast soreness.

Coitus Interruptus (Withdrawal Method):

• Safe for breastfeeding women, though they • Nurses play a vital role in educating and
may need to express and discard milk for 24 supporting individuals about their
hours. contraceptive choices.

• Not recommended for long-term Abortion

contraception.
refers to the interruption or expulsion of
Postcoital IUD Insertion: pregnancy before the fetus is viable (before
5-6 months of gestation).
• A copper IUD can be inserted within 5 days
of unprotected sex to prevent pregnancy. It can be:

• Works by affecting sperm and egg • Spontaneous (Miscarriage): Occurs

interaction. naturally due to medical conditions.

• May cause discomfort and heavier periods. • Induced (Elective or Therapeutic): A

voluntary termination performed by medical
• Not recommended if pregnancy is already
professionals.
suspected.
2. Spontaneous Abortion (Miscarriage)
4. Nursing Considerations
Causes:
• Nurses should provide nonjudgmental
education and counseling about • Chromosomal abnormalities (most
contraception. common)

• Women using emergency contraception • Hormonal imbalances

frequently should be advised to use a more
• Systemic diseases
reliable, regular method.
• Anatomical issues
• Nurses should recognize the emotional
distress some women may feel about Types of Spontaneous Abortion:
contraception and support their decisions.
• Threatened: Bleeding and cramping occur,
Key Takeaways but the cervix remains closed. Pregnancy
may still be saved with bed rest and medical
• Mechanical barriers (diaphragm, condoms,
care.
spermicides) physically block sperm but have
varying effectiveness. • Inevitable: The abortion cannot be stopped;
the cervix starts dilating.
• Fertility awareness methods require
tracking ovulation but are less reliable. • Incomplete: Some pregnancy tissue remains
in the uterus, requiring medical intervention
• Emergency contraception is a last resort,
(D&C or misoprostol).
not a primary method of birth control.
• Complete: All pregnancy tissue is expelled,
and no further treatment is needed.
• Habitual (Recurrent) Abortion: Three or • Laminaria (seaweed sticks) may be used to
more consecutive miscarriages. Requires soften the cervix beforehand.
genetic counseling and medical evaluation.
2. Dilation and Evacuation (D&E) – 14+ Weeks
Special Case: Incompetent Cervix
• Cervical dilation followed by vacuum
• The cervix dilates painlessly in the second
aspiration and possible surgical removal.
trimester, leading to miscarriage.
3. Medical (Medication) Abortion – Up to 10
• Treatment: Cervical cerclage (a surgical
Weeks
stitch to keep the cervix closed) and bed rest.
Medical Management • Mifepristone (blocks progesterone,
preventing implantation) followed by
• Saving expelled tissue for examination.
misoprostol (induces contractions).
• Monitoring bleeding with perineal pad
• Methotrexate (stops fetal cell growth, then
count.
misoprostol expels tissue).
• Oxytocin may be used to help the uterus
• Effectiveness: 95% but may cause
contract.
prolonged bleeding.
• Blood transfusions if there is heavy
4. Labor Induction – Late-Term Abortions
bleeding.
(Rare, for Medical Reasons)
Nursing Care
• IV oxytocin, prostaglandins, or saline/urea
• Provide emotional support, as women may injections induce labor.
experience grief or relief.
• Complications: Cardiovascular collapse,
• Offer counseling on future pregnancy pulmonary/kidney issues.
planning and contraceptive education.
4. Nursing Considerations in Induced
3. Induced Abortion (Medical or Surgical Abortion
Termination)
• Pre-procedure care:
Induced abortion is a voluntary termination
• Confirm pregnancy via ultrasound.
performed by trained medical providers.
Legal regulations vary by country and • Check hemoglobin (for anemia) and Rh
gestational age. status (give RhoGAM if needed).

Types of Induced Abortion: • Screen for STIs to prevent infections.

1. Vacuum Aspiration (Suction Curettage) – • Post-procedure care:

Up to 14 Weeks
• Educate on normal bleeding vs.
• Cervix is dilated, and tissue is removed via complications (heavy bleeding, fever, pain).
suction.
• Schedule a follow-up in 2 weeks.
• Most common method.
• Discuss contraceptive options for future • Ovarian & Ovulation Factors: Problems with
pregnancy prevention. ovulation due to hormone imbalances or
conditions like polycystic ovary syndrome
• Psychological Support:
(PCOS).
• Women seek abortion for various reasons
• Tubal & Uterine Factors: Blocked fallopian
(health risks, genetic defects, rape, financial
tubes, uterine abnormalities (e.g., fibroids,
concerns).
polyps, endometriosis).
• Nurses must provide nonjudgmental care.
For Men:
• Nurses have the right to refuse
• Low sperm count & poor sperm quality
participation based on personal beliefs but
(normal is 60–100 million sperm/mL; issues
cannot impose their views on patients.
arise below 15 million/mL).
Key Takeaways:
• Varicoceles (varicose veins around the
• Spontaneous abortion (miscarriage) is often testicles) can increase temperature and harm
due to genetic defects or medical conditions. sperm.

• Induced abortion can be done via • Hormonal imbalances (testosterone, FSH,

medication or surgery, depending on LH).
gestational age.
3. Diagnosis
• Emotional and psychological support is
• Women: Blood tests (progesterone, LH),
critical in both cases.
ovulation tests, ultrasounds,
• Nurses must respect patient choices while hysterosalpingography (HSG) to check the
ensuring proper education on contraception uterus and fallopian tubes, laparoscopy.
and post-abortion care.
• Men: Semen analysis, hormone blood tests,
Infertility urinalysis for retrograde ejaculation.

• Infertility is the inability to conceive after 4. Treatment Options

one year of unprotected penile-vaginal
A. Medication-Based Treatments • Ovulation
intercourse. It affects about 1 in 8 couples in
induction drugs:
the U.S.
• Clomiphene citrate (Clomid): Stimulates
• Primary infertility: When a couple has never
ovulation.
had a child.
• Menotropins (FSH + LH): Helps stimulate
• Secondary infertility: When a couple has
egg production.
conceived before but is now unable to
achieve pregnancy. • Metformin: Used for PCOS to regulate
ovulation.
2. Causes of Infertility For Women:
• Progesterone: Supports uterine lining after
ovulation.
• Dopamine agonists (e.g., Bromocriptine): • Folic acid supplements for women.
Treats high prolactin levels that inhibit
• Good glycemic control for women with
ovulation.
diabetes.
• Risks: Multiple pregnancies (twins, triplets),
• Alternative options: Adoption, surrogacy, or
ovarian hyperstimulation syndrome (OHSS)
child-free living.
(fluid buildup in the abdomen and lungs).
Ectopic Pregnancy
B. Artificial Insemination (AI)
• An ectopic pregnancy occurs when a
• Intrauterine insemination (IUI): Process of
fertilized egg implants outside the uterus,
placing sperm directly into the uterus. Used
most commonly in the fallopian tube.
when sperm quality is poor or when there are
cervical issues. • While the incidence and mortality rates are
decreasing, ectopic pregnancy remains the
• Donor sperm may be used in cases of male
leading cause of first-trimester pregnancy-
infertility.
related deaths due to rupture and internal
C. Assisted Reproductive Technologies (ART) bleeding (ACOG, 2018).

• In Vitro Fertilization (IVF): 2. Causes and Risk Factors Possible causes: •

Pelvic infections (salpingitis, PID) leading to
• Eggs are retrieved, fertilized with sperm in
scarring.
a lab, then transferred into the uterus.
• Structural abnormalities of the fallopian
• Success rates are higher when multiple
tube.
embryos are used.
• Previous ectopic pregnancy or tubal
• Intracytoplasmic Sperm Injection (ICSI):
surgery.
• A single sperm is injected directly into an
• Multiple prior induced abortions.
egg. Used for severe male infertility.
• Endometriosis (causes scarring and
• Gamete Intrafallopian Transfer (GIFT):
adhesions).
• Sperm and egg are placed into the fallopian
• Pelvic tumors that distort the fallopian tube.
tube instead of fertilizing outside the body.
Additional risk factors:
Often chosen for religious reasons.
• Use of tobacco products.
5. Nursing & Lifestyle Considerations
• History of IUD use (though rare,
• Stress management and emotional support
pregnancies that occur with an IUD in place
for couples.
have a higher chance of being ectopic).
• Healthy lifestyle:
• Fertility treatments, including ovulation-
• Stop smoking (including e-cigarettes). inducing drugs.

• Maintain a healthy weight.

3. Clinical Manifestations (Signs & • Transvaginal ultrasound:
Symptoms)
• Detects the location of pregnancy outside
• Early symptoms can mimic a normal the uterus.
pregnancy or mild discomfort:
• If fetal heart activity is seen outside the
• Slightly delayed period (1–2 weeks). uterus, ectopic pregnancy is confirmed.

• Light spotting (may be mistaken for a • Laparoscopy:

period).
• If diagnosis is unclear, a small camera is
• Mild pelvic pain or soreness on one side. inserted into the abdomen to examine the
fallopian tubes directly.
• If untreated, symptoms worsen:
5. Treatment and Management
• Sharp, colicky pain in the lower abdomen.
A. Surgical Management (for larger or
• Dizziness or lightheadedness.
ruptured ectopic pregnancies)
• Gastrointestinal symptoms (nausea,
• Salpingotomy: The fallopian tube is opened,
bloating).
the ectopic pregnancy is removed, and the
• Shoulder and neck pain (from internal tube is repaired.
bleeding irritating the diaphragm).
• Salpingectomy: If damage is severe, the
• Signs of a ruptured ectopic pregnancy: fallopian tube is completely removed.

• Severe abdominal pain, sudden and sharp. • Salpingo-oophorectomy: In extreme cases,

both the fallopian tube and ovary are
• Fainting, dizziness, or shock symptoms
removed.
(rapid pulse, low blood pressure, sweating,
restlessness). B. Pharmacologic Management (for small,
unruptured ectopic pregnancies)
• Pale skin (pallor) due to internal
hemorrhage. • Methotrexate (MTX):

4. Diagnosis and Assessment • A chemotherapy drug that stops cell

growth, preventing the pregnancy from
• Pelvic exam: May detect a tender mass in
developing further.
the adnexal area (near the ovary and
fallopian tube). • Given only if the patient is stable (no
internal bleeding, small ectopic pregnancy,
• hCG levels (pregnancy hormone):
no fetal heartbeat).
• Normally, hCG levels double every 3 days in
• Can also be used after surgery to clear
a healthy pregnancy.
remaining ectopic tissue.
• In ectopic pregnancies, hCG levels rise more
6. Nursing Considerations and Patient
slowly or remain low.
Education
• Early detection is crucial—women should • Lack of knowledge regarding ectopic
seek medical help if they experience pregnancy, treatment, and future risks.
abnormal bleeding or pain.
3. Collaborative Problems & Potential
• Educate patients on risk factors (e.g., Complications
previous PID, smoking, IUD use).
• Hemorrhage: Due to rupture of the
• Monitor for complications: Shock, infection, fallopian tube.
or emotional distress following pregnancy
• Hemorrhagic shock: From excessive blood
loss.
loss.
• Future fertility concerns: If one tube is
4. Planning & Goals
removed, fertility decreases but pregnancy is
still possible with the remaining tube. • Relief of pain using medication and
positioning.
1. Assessment
• Emotional support to help the patient cope
• History Taking:
with pregnancy loss.
• Evaluate the menstrual pattern and any
• Increased knowledge about ectopic
abnormal bleeding since the last period.
pregnancy and future risks.
• Ask about pain location and characteristics
• Prevention of complications, including
(sharp, colicky, radiating to shoulder/neck).
hemorrhage and shock. Nursing
• Physical Examination: Interventions

• Monitor vital signs (pulse, BP, temperature). A. Relieving Pain

• Assess level of consciousness for signs of • Pre-surgical pain relief: Administer

shock. analgesics as prescribed.

• Observe nature and amount of vaginal • Postoperative pain control: Provide

bleeding. adequate pain medication to encourage
early ambulation, deep breathing, and
• Emotional and Psychological Assessment:
coughing.
• Evaluate how the patient is coping with
B. Supporting the Grieving Process
pregnancy loss.
• Recognize that grief varies by patient. •
2. Nursing Diagnoses
Offer emotional support and allow the
• Acute pain related to the ectopic patient to express feelings.
pregnancy.
• Include the partner in discussions, if
• Grief related to the pregnancy loss and its appropriate.
impact on future fertility.
• Refer to counseling services if needed.
C. Monitoring and Managing Potential 2. Emotional Adjustment
Complications
• Begins to accept pregnancy loss and
• Monitor for hemorrhage and shock: expresses grief.

• Frequent vital signs monitoring (BP, HR, RR, 3. Increased Knowledge

temperature).
• Understands the causes, treatment, and
• Assess level of consciousness. risks of ectopic pregnancy.

• Track vaginal bleeding (pad count, color, 4. No Complications

and consistency).
• No excessive bleeding, normal vital signs,
• Monitor hematocrit, hemoglobin, and and stable condition.
blood gases for signs of blood loss.
•hCG levels return to normal.
• Intervene promptly for shock: • Prepare for
Ectopic Pregnancy
IV fluid replacement.
An ectopic pregnancy occurs when a
• Arrange for blood transfusion if needed.
fertilized egg implants outside the uterus,
• Ensure bed rest and oxygen administration most commonly in the fallopian tube.
as needed.
This condition is dangerous because it can
• Prepare for emergency surgery if indicated. cause internal bleeding and requires
D. Educating Patients for Home & Transitional immediate medical attention.
Care
2. Perimenopause and Menopause
• Explain procedures and recovery
Perimenopause is the transition period
expectations in simple, clear terms.
before menopause, lasting about 4 years.
• Inform about future pregnancy risks: Higher
It includes hormonal fluctuations and
risk for ectopic pregnancy recurrence.
irregular menstrual cycles.
• Teach warning signs:
Menopause is defined as 12 consecutive
• Report abnormal periods, severe pain, or months without menstruation, typically
heavy bleeding immediately. occurring between ages 41–59.

• Encourage preconception counseling Postmenopause begins one year after the last
before future pregnancies. period and is marked by lower estrogen
levels, leading to various body changes.
5. Evaluation: Expected Patient Outcomes
Nursing Management for Perimenopause &
1. Pain Relief
Menopause
• Reports decreased pain and performs
• Key Health Considerations:
activities (e.g., ambulation, deep breathing).
• Contraception & STIs: Women can still • Patient Education:
conceive during perimenopause, so
• Menopause is a natural transition, not a
contraception is advised until 1 year after the
disease.
last period.
• Encourage healthy diet, regular exercise,
• Breast health: Regular self-exams,
and mental well-being.
mammograms, and clinical checkups are
essential, as 16% of breast cancer cases occur • Report any postmenopausal vaginal
during perimenopause. bleeding immediately.

• Common Symptoms: Key Takeaways for Nurses:

• Irregular periods, hot flashes, night sweats, • Ectopic pregnancy requires early detection
mood swings, vaginal dryness, and sleep and urgent intervention to prevent
issues. hemorrhage

• Decreased bone density (osteoporosis risk). . • Perimenopause & menopause require

patient education, symptom management,
• Increased heart disease risk due to lower
and lifestyle modifications.
estrogen levels.
• Hormone therapy can help, but must be
• Hormone Therapy (HT):
used cautiously.
• HT (estrogen alone or combined with
• Encourage preventative health measures
progestin) helps with hot flashes and night
for osteoporosis, heart disease, and mental
sweats.
well-being.
• Recommended at the lowest dose for the
shortest time.

• Not suitable for women with breast cancer,

blood clots, liver disease, or unexplained
vaginal bleeding.

• Alternative Therapies for Hot Flashes:

• Lifestyle changes, vitamin B6 & E, black

cohosh, soy, yoga, and meditation may help.

• Bone & Heart Health:

• Increase calcium & vitamin D intake.

• Avoid smoking, alcohol, and excessive

caffeine.

• Perform weight-bearing exercises to

prevent osteoporosis.