Study Notes For Female Reproductive Problems

Study Notes for Female Reproductive Problems
INFERTILITY
 Infertility is the inability to achieve a pregnancy after at least 1 year of regular intercourse without
contraception.
 Diagnostic studies include ovulatory studies, tubal patency studies, and postcoital studies.
 Management depends on the cause and can include supplemental hormone therapy and antibiotic
therapy.
ABORTION
 Abortion is the loss or termination of a pregnancy before the fetus has developed to a state of viability.
 Abortions are classified as spontaneous (those occurring naturally) or induced (those occurring as a
result of mechanical or medical intervention).
 Nursing management includes the use of comfort measures to provide needed physical and mental rest.
The support of the patient and her family is essential.
PREMENSTRUAL SYNDROME
 Premenstrual syndrome (PMS) is a common disorder of physical and psychologic symptoms during
the last few days of the menstrual cycle and before onset of menstruation.
 PMS is thought to have a biologic trigger with compounding psychosocial factors.
 Physical symptoms include breast discomfort, abdominal bloating, sensation of weight gain, episodes of
binge eating, and headache. Anxiety, depression, irritability, and mood swings are some of the
emotional symptoms.
 No single treatment is available to relieve symptoms. The goal is to reduce symptom severity.
DYSMENORRHEA
 Dysmenorrhea is abdominal cramping pain or discomfort associated with menstrual flow.
o Primary dysmenorrhea is caused by an excess of prostaglandin F2α (PGF2α) and/or an increased
sensitivity to it.
o Secondary dysmenorrhea is acquired after adolescence; pelvic causes include endometriosis,
chronic pelvic inflammatory disease, and uterine fibroids.
 Treatment for primary dysmenorrhea includes heat, exercise, and drug therapy. For secondary
dysmenorrhea, it depends on the cause.
 Abnormal vaginal or uterine bleeding is a common gynecologic concern and is caused by dysfunction of
hypothalamic-pituitary-ovarian axis, infection, and stressful changes in lifestyle. Treatment varies
depending on the cause but can include drug therapy and surgery.
ECTOPIC PREGNANCY
 An ectopic pregnancy is the implantation of the fertilized ovum anywhere outside the uterine cavity.
 Any blockage of the tube or reduction of tubal peristalsis that impedes or delays the zygote passing to
the uterine cavity can result in tubal implantation.
 Risk factors include a history of pelvic inflammatory disease, prior ectopic pregnancy, current progestin-
releasing intrauterine device (IUD), progestin-only birth control failure, and prior pelvic or tubal
surgery.
 Eventually the tube ruptures with acute peritoneal symptoms of abdominal/ pelvic pain, missed menses,
and irregular vaginal bleeding. Less acute symptoms begin 6 to 8 weeks after last normal menstrual
period.
 Surgery is usually the treatment.
MENOPAUSE
 Menopause is the physiologic cessation of menses associated with declining ovarian function. It is
usually considered complete after 1 year of amenorrhea.
 Ovarian changes start the cascade of events that result in menopause.
 Premenopausal symptoms include hot flashes, irregular vaginal bleeding, fat redistribution, and a
tendency to gain weight.
 Treatment might include hormone replacement, drug therapy, and alternative therapies.
INFECTION AND INFLAMMATION OF VAGINA, CERVIX, AND VULVA

 Infection and inflammation of vagina, cervix, and vulva commonly occur when natural defenses of the
acid vaginal secretions (maintained by sufficient estrogen levels) and presence of Lactobacillus are
disrupted.
 Abnormal vaginal discharge and reddened vulvar lesions are often noted with itching and dysuria.
 Treatment includes antibiotics and antifungal preparations.
PELVIC INFLAMMATORY DISEASE

 Pelvic inflammatory disease (PID) is an infectious condition of pelvic cavity that may involve
infection of fallopian tubes (salpingitis), ovaries (oophoritis), and pelvic peritoneum (peritonitis).
 PID is often the result of untreated cervicitis.
 The main symptom is constant lower abdominal pain.
 Long-term complications include ectopic pregnancy, infertility, and chronic pelvic pain.
 PID is usually treated with antibiotics.
ENDOMETRIOSIS
 Endometriosis is the presence of normal endometrial tissue in sites outside endometrial cavity.
 One cause is retrograde menstrual flow through the fallopian tubes carrying viable endometrial tissues
into the pelvis.
 Symptoms are secondary dysmenorrhea, infertility, pelvic pain, dyspareunia, and irregular bleeding.
 Drug therapy reduces symptoms with surgery for a potential cure.
LEIOMYOMAS
 Leiomyomas (uterine fibroids) are benign smooth-muscle tumors that occur within the uterus.
 Symptoms may include abnormal uterine bleeding, and pain.
 Treatment depends on size of tumor and may include surgery.
CERVICAL CANCER
 There is a strong relationship between sexual exposure of papillomavirus (HPV) and dysplasia.
 Later signs are leukorrhea, intermenstrual bleeding, and pain.
 The finding of an abnormal Pap test indicates need for follow-up.
 Invasive disease is treated with surgery, radiation, and chemotherapy.
 A new vaccine can protect against most types of cervical cancer.
ENDOMETRIAL CANCER
 The major risk factor of endometrial cancer is unopposed estrogen.
 It has low mortality rate, as most cases are diagnosed early.
 The first sign of endometrial cancer is abnormal uterine bleeding.
 Treatment is total hysterectomy and bilateral salpingo-oophorectomy with lymph node biopsies.
Radiation and chemotherapy may also be given.
OVARIAN CANCER
 The etiology of ovarian cancer is generally not known.
 Most women with ovarian cancer have advanced disease at diagnosis.
 The greatest risk factor is family history.
 In the early stages, manifestations are vague and may consist of abdominal discomfort (gas, indigestion,
pressure, bloating, cramps) and change in bowel habits.
 Yearly bimanual pelvic examinations should be performed to identify an ovarian mass.
 Treatment includes surgery, chemotherapy, and radiation.
 Nurses can teach women importance of routine screening for cancers of the reproductive system.
UTERINE PROLAPSE
 Uterine prolapse is the downward displacement of uterus into the vaginal canal.
 Symptoms are dyspareunia, dragging or heavy pelvic feeling, backache, and bowel or bladder problems
if cystocele or rectocele is also present.
 Therapy depends on degree of prolapse and can include strengthening exercises, and a pessary.
SEXUAL ASSAULT
 Sexual assault is the forcible perpetration of a sexual act on a person without his or her consent. It can
include sodomy, forced vaginal or anal intercourse, oral copulation, and assault with a foreign object.
 Physical injuries may include bruising and lacerations to perineum, hymen, vulva, vagina, cervix, and
anus.
 Feelings of humiliation, degradation, embarrassment, anger, self-blame, and fear of another assault are
commonly expressed.
 Ensuring the woman’s emotional and physical safety is the highest priority.
 Follow-up physical and psychologic care is essential.

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Study Notes for Female Reproductive Problems

 PMS is thought to have a biologic trigger with compounding psychosocial factors.

 Surgery is usually the treatment.

 Ovarian changes start the cascade of events that result in menopause.

INFECTION AND INFLAMMATION OF VAGINA, CERVIX, AND VULVA

 Treatment includes antibiotics and antifungal preparations.

PELVIC INFLAMMATORY DISEASE

 PID is often the result of untreated cervicitis.

 The main symptom is constant lower abdominal pain.

 PID is usually treated with antibiotics.

 Drug therapy reduces symptoms with surgery for a potential cure.

 Symptoms may include abnormal uterine bleeding, and pain.

 Treatment depends on size of tumor and may include surgery.

 Later signs are leukorrhea, intermenstrual bleeding, and pain.

 The finding of an abnormal Pap test indicates need for follow-up.

 Invasive disease is treated with surgery, radiation, and chemotherapy.

 A new vaccine can protect against most types of cervical cancer.

 It has low mortality rate, as most cases are diagnosed early.

 The first sign of endometrial cancer is abnormal uterine bleeding.

 Most women with ovarian cancer have advanced disease at diagnosis.

 The greatest risk factor is family history.

 Yearly bimanual pelvic examinations should be performed to identify an ovarian mass.

 Treatment includes surgery, chemotherapy, and radiation.

 Follow-up physical and psychologic care is essential.

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