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Medical-Surgical Nursing

20.1 Brief Review of Genitourinary and Reproductive Anatomy and Physiology

Medical-Surgical Nursing20.1 Brief Review of Genitourinary and Reproductive Anatomy and Physiology

Learning Objectives

By the end of this section, you will be able to:

  • Discuss the anatomy and physiology of the male genitourinary and reproductive systems.
  • Discuss the anatomy and physiology of the female genitourinary and reproductive systems.

Because of their anatomic proximity, the term genitourinary system is used to describe organs of both the reproductive and urinary systems. The reproductive portion of the genitourinary system consists of the male or female genitalia and associated components involved in biological reproduction of offspring. The urinary portion of the genitourinary system, also known as the renal system, includes the kidneys, ureters, bladder, and urethra, all of which play a major role in fluid and electrolyte balance and the excretion of waste as urine. Because of the anatomic proximity of these organs, it is not uncommon for a disorder of one system to potentially affect the other organs.

Anatomy and Physiology of the Male Genitourinary and Reproductive Systems

The male genitourinary system consists of two major organs—the penis and the testicles—in addition to several other internal structures, which are depicted in Figure 20.2. The penis is located external to the body, and its components include the glans, urethra, and external urethral opening. The urethra is a long, thin tube that runs the length of the penis and carries semen or urine for eventual excretion from the body. It is approximately 20 cm (7–8 inches) long, on average, and transports both urine and semen. The glans is the bulbous structure at the distal end of the penis and is responsible for excreting both semen during ejaculation and urine as waste from the external urethral opening. Urine is normally carried from the urinary bladder through the urethra for excretion, but this function ceases during times of sexual arousal and semen ejaculation. Therefore, although the penis can release both urine and semen from the same urethral opening, they cannot be excreted simultaneously (Cleveland Clinic, 2020b).

A diagram showing a lateral view of the various parts of the male reproductive system. Labeled parts include: prostate gland, suspensory ligament of penis, urinary bladder, public symphysis, corpus cavernosum, corpus spongiosum, external urethral opening, scrotum, epididymis, testis, ductus (vas) deferens, spongy urethra, membranous urethra, muscles of perineum surrounding anus, bulbourethral gland, deep muscles of perineum, prostatic urethra, ejaculatory duct, seminal vesicle, and ampulla of ductus deferens.
Figure 20.2 The male genitourinary and reproductive systems consist of the penis, testicles, and several internal components. (credit: modification of work from Anatomy and Physiology 2e. attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Male reproduction is a complicated process with several internal components that affect the function. The testicles (testes), referred to as the male sex glands, are found in the scrotum, which is an outpouching of skin located below the penis. The testes contained in this sac are at a slightly lower temperature than the rest of the body, allowing for spermatogenesis, or sperm production, to occur at the ideal temperature, which is approximately 4 degrees lower than normal internal human temperature. In addition to producing sperm, the testicles are also responsible for secreting testosterone, the male sex hormone, which affects male secondary sex characteristics and libido. The testicles secrete sperm into the epididymis, a tube where sperm can grow and mature. After maturation, the sperm is sent from the epididymis through the vas deferens to the seminal vesicle, where sperm collects in preparation for eventual ejaculation through the urethral opening. Two small glands, known as bulbourethral (or Cowper’s) glands are located on either side of the urethra and secrete fluid, called pre-ejaculate, for lubrication and movement through the urethra during ejaculation. Another important part of the male reproductive system is the prostate gland. This gland sits just below the urinary bladder and is responsible for secreting a substance that helps lubricate, nourish, and expel the sperm during ejaculation.

Anatomy and Physiology of the Female Genitourinary and Reproductive Systems

The female genitourinary system consists of several parts; these are depicted in Figure 20.3 and Figure 20.4. The female urinary bladder connects to the urethra, which is approximately 3 to 4 cm (1.5 inches) long, and allows for excretion of urine as waste. The clitoris, a small mound of tissue that is highly sensitive to stimulation, is directly above the urethral opening. Directly below the urethral opening is the vaginal opening, through which blood exits the body during menstruation and through which the infant is delivered during childbirth. In contrast to male anatomy, which only provides one opening for both urine and semen for reproduction, the female anatomy consists of two different openings, one for urine excretion and one for reproductive function (Cleveland Clinic, 2022).

A diagram showing a lateral view of the various parts of the female reproductive system. Labeled parts include: bladder, public symphysis, mons pubis, urethra, clitoris, labium minora, labium majora, anus, vagina, rectum, cervix, fornix of uterus, ovary, uterus.
Figure 20.3 The internal portions of the female genitourinary and reproductive systems include the uterus, ovaries, fallopian tubes, vagina, bladder, and urethra. (credit: modification of work from Anatomy and Physiology 2e. attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)
A diagram showing the internal and external parts of the female genitourinary and reproductive systems. Labeled parts include: prepuce, glans clitoris, labia minora, corpus cavernosum, bulb of vestibule, urethra opening, labia majora, vaginal opening, opening of right Bartholin's gland, anus.
Figure 20.4 The external parts of the female genitourinary and reproductive systems include the clitoris, labia, urethral opening, and vagina. (credit: modification of work from Anatomy and Physiology 2e. attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

The vagina is a tube-like muscular organ, also known as the vaginal canal or birth canal. The external opening of the vagina is surrounded by connective tissue, divided into two folds of tissue called the labia majora and labia minora. The vagina is connected to the cervix, which is the lower opening of the uterus. The cervix serves as a barrier between the vaginal canal and the uterus, which helps protect a growing fetus from developing an infection during pregnancy. The uterus is a large, hollow organ that holds the fetus during pregnancy, allowing it to grow and mature in preparation for childbirth. The female reproductive system also includes the ovaries and the fallopian tubes. The ovaries produce eggs for reproduction and estrogen, the female sex hormone. It is estimated that each ovary contains up to 1 million eggs at birth and begins a cycle of maturation and release after puberty. The release of an egg from one of the ovaries is known as ovulation and occurs generally once a month based on the cycle of female hormones. The egg travels through one of the fallopian tubes to the uterus. If the egg is joined by sperm from a male, fertilization and conception may occur, resulting in pregnancy.

Menstrual Cycle

The female reproductive system is controlled by a monthly hormone fluctuation referred to as the menstrual cycle. Cycle lengths vary, but a typical cycle lasts for approximately one month, or about 28 days. Figure 20.5 depicts the different phases and hormones associated with each day of the cycle. The first 14 days of the menstrual cycle represent the follicular phase. During the first three to seven days of this phase, menstruation, or the shedding of the uterine lining through the vagina, is occurring. While this is happening, the ovaries develop mature eggs for potential reproduction. Approximately 11 to 15 days after menstruation, one of the eggs matures enough to be released, resulting in ovulation. The transition from menstruation to ovulation is triggered by changes from estrogen to progesterone and follicle-stimulating hormone made in the anterior pituitary gland. The egg travels from the ovary through a fallopian tube to the uterus for possible fertilization with a sperm. After ovulation, the luteal phase begins. This phase marks the second half of the menstrual cycle, lasting approximately 14 days. Levels of follicle-stimulating hormone and luteinizing hormone decrease, which triggers the next phase. During this phase, the hormone progesterone is produced in large amounts, which results in thickening of the uterine lining in readiness for the possible implantation of a fertilized egg. If the egg does become fertilized, it will implant into the uterine wall, which will result in pregnancy, cessation of the menstrual cycle, and eventual childbirth. If the egg is not fertilized by sperm during this phase, pregnancy does not occur and the uterine lining begins to break down in preparation of shedding, marking the start of a new menstrual cycle.

A complex diagram showing the phases of the female menstrual cycle. The diagram is presented in four layers. Layer one is the ovarian cycle layer showing the growth and degeneration of the follicle. Layer two is the uterine cycle showing the menstrual flow, proliferative phase, and secretory phase. Layer three is the pituitary hormone level layer showing the rising FSH and LH at the point of ovulation. Layer four is the ovarian hormone level showing rising estradiol just before ovulation and rising progesterone just after ovulation.
Figure 20.5 Hormone levels vary throughout the menstrual cycle by day as the uterus prepares for a possible pregnancy. The uterine lining is shed if implantation does not occur. (credit: Warren et al./Frontiers in Global Women's Health, CC BY 4.0)

Both the male and female genitourinary systems are complex and consist of many different structures and organs that must function optimally for reproduction to occur. Some of the many disorders and conditions that can affect both systems will be discussed in more detail in this chapter.

Cultural Context

Gender Identity Considerations

It is important to understand that a patient’s biological sex may not always match their gender identity. Gender identity is “one’s innermost concept of self as male, female, a blend of bother or neither—how individuals perceive themselves and what they call themselves” (HRC Foundation, n.d.). For example, a patient who is assigned male sex at birth may identify with socially traditional characteristics and interests of women and wish to identify as a woman. Although some patients may simply identify as a different gender than their assigned birth gender, other patients may actively pursue medical treatment and interventions to physically change their body and sex organs to match their preferred gender. Every patient is unique, and nurses should approach each patient in a nonjudgmental manner to ensure optimal care and improved patient outcomes. It is important to note that during medical care, it is reasonable for clinicians to ask a person about their biological sex at birth, because implications of sex hormones are relevant in many health conditions and knowing a patient’s biological sex helps direct guidelines for preventive screenings.

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