Escolar Documentos
Profissional Documentos
Cultura Documentos
NURSING
Anatomy Recall
Common Gynecological Complaints
Vaginal discharge
Vaginal/ Vulvar pruritus
Genital ulceration
Inguinal lymphadenopathy
Pelvic mass
Dyspareunia
Pelvic pain
Vaginal bleeding
Amenorrhea
COMMON GYNECOLOGIC
PROBLEM
VULVOVAGINITIS
SALPHINGITIS
PREMENSTRUAL SYNDROME
PRIMARY DYSMENORRHEA
SECONDARY DYSMENORRHEA
ENDOMETRIOSIS
Gynecological Infections
Lower genital tract Sexually Transmitted
Vulvitis Diseases/ Infections
Vaginitis (STD/ STI)
cervicitis Bacterial
Viral
Upper genital tract Others
Endometritis
Pelvic inflammatory disease
(PID)
Diagnostic Tests
Bloodwork Genital tract biopsy
- CBC - vulvar
- HCG - vaginal
- LH, FSH, TSH, PRL - endometrial
Imaging
Vaginal/ endocervical
culture
- Ultasound VDRL
- Hysterosalpingography Papanicolau Smear
- Sonohystography Colposcopy
Laparoscopy
VULVOVAGINITIS
Infectious diseases and other inflammatory
conditions affecting the vaginal mucosa and
involving vagina
CAUSES
Bacteria- gardnerella vaginalis
Protozoa – trichomonas vaginalis
Candida
Human papilloma virus (HPV)
Causes ( irritation)
Frequent douching
Deodorant spray
Laundry soap and fabric softener
Bath water additives
Tight non-porous, non-absorbent underclothing
Poor hygiene
Coital lubricant
Latex in diaphragm or condom
VULVOVAGINITIS
Manifestation
Vaginal discharge
Candida – thick, cheesy discharge
Bacterial vaginosis – The fishy smell is stronger after sexual
intercourse , thin, milky white discharge that clings to the
walls of the vagina
Trichomonas – painful urination, painful sexual intercourse,
and a yellow-green to gray, foul smelling, sometimes frothy,
vaginal discharge.
Vulvar irritation
Pruritus
Burning pain
Management
Complete physical examination & history
Note the discharge ( color, consistency, presence
of odor, duration and symptoms )
Vulva is examined for redness, edema and
excoriation and abnormal lesion
sample of the vaginal discharge for tests and
microscopic analysis.
Vaginal culture
Pap smear
Treatment
Specific causes of discharge require specific
therapy
Candida – miconazole 2% or clotrimazole 1%
cream, vaginal tablet or suppositories x3-7days
Trichomonas – metronidazole 500mg BID p.o x
5days or 250 mg tid. Sexual partner also treated.
douche
Nursing care
Patient Education
Vaginal infections may be prevented by following
these suggestions:
Over-the-counter yeast infection treatments should not be
taken unless the woman had been diagnosed with
candidiasis before and recognizes the symptoms.
Douching should be avoided because it may disturb the
balance of organisms in the vagina and may spread them
higher into the reproductive system.
A vaginal douche is a process of rinsing or cleaning the
vagina by forcing water or another solution into the vaginal
cavity to flush away vaginal discharge or other contents.
Nursing care
Thoroughly dry oneself after bathing and remove a
wet bathing suit promptly.
Avoid wearing tight clothing and wear cotton
underwear.
Clean diaphragms, cervical caps, and spermicide
applicators after use. Use condoms to avoid
sexually transmitted disease.
After a bowel movement, wipe from front to back
to avoid spreading intestinal bacteria to the
vagina.
Antioxidant vitamins, including A, C, and E,
as well as B complex vitamins, and vitamin
D, are recommended.
Foods to avoid include cheese, alcohol,
chocolate, soy sauce, sugar, fruits, and any
fermented foods.
Wearing cotton underwear and loose fitting
clothes and avoiding panty hose can help
keep the vagina cool and dry, thus helping
to prevent some forms of vulvovaginitis.
CANDIDA VAGINITIS
Treament
Oral agent: Fluconazole 150 mg (single dose)
Vaginal agents: antifungal preparation (fungicidal azole
creams: Clotrimazole, Miconazole) for 3 to 7 days
Nystatin –vaginal suppository twice a day for 7 to 14
days or
Clotrimazole vaginal suppository at bedtime for 7 days
or
Miconazole nitrate vaginal cream applied nightly for 7
days
Nursing interventions
Client teaching:
not wearing underwear to bed
wearing cotton-crotched underwear
completing full course of treatment even during menstruation
avoiding feminine sprays, deodorants, scented pads
(allergies and irritation)
Vitamin C, live culture yogurt - increase vaginal acidity
Local application of anti fungal agents (eg, Nystatin)
Inform the patient that the disease can be transmitted to the
newborn leading to the development of ORAL THRUSH
Home Remedies:
Vaginal douche of two teaspoons ordinary baking
Causes
if the duct becomes
blocked for any reason:
infection,
injury or chronic
inflammation
Very rarely, caused by
cancer
Unknown (many cases)
BARTHOLIN’S CYST
Causative organisms: Staphylococcus aureus
(others: S. fecalis, E. coli, N. gonorrhea, C. thromatis)
Symptoms:
Bartholin’s Cyst (asymptomatic)
Bartholin’s Abscess - pain or tenderness, dyspareunia
Diagnosis
clinical
Management
incision and drainage
marsupialization – entire abscess is incised and sewn open
Word catheter for 2 – 4 weeks
broad spectrum antibiotic
BARTHOLIN’S CYST
Nursing interventions
Teach the importance of completing the course of
antibiotic
Teach the importance of good hygiene
Sitz bath – for both pain relief and to decrease healing
time
SALPHINGITIS
AT RISK
Occur predominantly in women under 35 yrs old
Sexually active
Child birth ( peurperal fever)
Abortion
IUDs
SALPHINGITIS
CAUSES:
Chlamydia trachomatis 15-75 %
Neisseria gonorrhea
Other associated organisms include Ureaplasma
urealyticum, Mycoplasma genitalium,
Trichomonas vaginalis, Gardnerella vaginalis,
and mixed anaerobic and aerobic bacteria
SALPHINGITIS
SYMPTOMS
Onset usually shortly after menses
Lower abdominal pain progressive
With guarding
Rebound tenderness
Discomfort increases with cervical motion
Vomiting
Bowel normal initially paralytic ileus
Copious purulent cervical discharge
High fever
SALPHINGITIS
Complication
Abscess may develop in
Tubes
Ovaries
pelvis
DIAGNOSIS
History of:
recent coitus
Insertion of IUD
Childbirth
Abortion
Temperature elevation
CBC
Wbc elevated
Culture & smear for Gram stain
Culdocentesis – examination of fluid
Laparoscopy
SALPHINGITIS
TREATMENT:
Stop infection to prevent infertility
Antibiotic-PO antibiotics for a full 2-week course
NURSING CARE
Examination & treatment of sexual contact
Treat all sex partners that the patient has had within the 60
days prior to symptom onset.
Patient education
Women should remain abstinent from sexual activity until
they are cured of symptoms and they have completed their
full regimen of antibiotics
Patient education
Primary prevention involves avoiding either
exposure to STDs or acquisition of infection
following exposure.
Counsel patients regarding safe sex practices in
a manner appropriate to both the patient's
understanding of sexual issues and stage of
development.
Advise patients to avoid high-risk sex partners
and limit their number of sex partners.
Patients who present for STD evaluation should
be given hepatitis B vaccination.
SEXUALLY
TRANSMITTED
INFECTION
SEXUALLY TRANSMITTED
DISEASES/INFECTION ( STD/STI)
Trichomoniasis
Chlamydia
Gonorrhea
Syphilis
Herpes simplex
Condylomata acuminatum
TRICHOMONIASIS
Diagnosis
microscopic exam of vaginal discharge
Management
Sexual partner should receive oral treatment.
Metronidazole (Flagyl) 500 mg BID for 7 days or a single 2 g
dose (contraindicated during pregnancy)
Home Remedy
Acidic vaginal douche : 1 tablespoon vinegar with 1 liter
water to counteract the alkaline environment of the vagina
that favors the growth of Trichomonas vaginalis
Nursing interventions
Include sexual partner in treatment.
Advise use of condom during intercourse
Nursing alerts:
- Concurrent alcohol ingestion with Metronidazole causes
severe GI symptoms (Antabuse-like reaction)
- Metronidazole is associated with preterm labor,
premature rupture of membranes and postcesarean
infection
CHLAMYDIA
Risk Factors
Sexual activity < 20 years
Multiple sexual partners
Lower socioeconomic status
(+) others STDs
Signs and symptoms
May be asymptomatic
Gray white/ yellowish vaginal discharge
Burning and itchiness
Bleeding between periods
Mucopurulent cervicitis
Painful and frequent urination
Diagnosis
(+) culture/ antigen detection test on cervical smear
Polymerase chain reaction (PCR)
Management
Doxycycline 100 mg PO BID for 7 days
(causes fetal long bone deformity if used in pregnancy)
Azithromycin (Zithromax) 1 g PO in a single dose
Erythromycin 500 mg QID for pregnant patient
Patient may also be treated for gonorrhea with a single IM shot of
Ceftriaxone 250 mg
Infant treated with Erythromycin ophthalmic ointment
Nursing interventions
Client teaching:
Teach the importance of completing the course of antibiotic
Use condom during sex
Sexual partner should receive treatment
Complications
Pelvic inflammatory disease (PID)
Ectopic pregnancy
Fetus transmittal (vaginal birth);
may cause conjunctivitis
(also associated with premature rupture of membranes,
preterm labor and endometriosis, low birth weight and
perinatal mortality due to placental transmission)
GONORRHEA
Complications
PID
ectopic pregnancy
infertility
Chorioamnionitis
ophthalmia neonatorum
in newborns (associated
with severe eye infection
and blindness)
preterm delivery
sterility & pelvic
inflammatory disease
Management (single dose only)
Ceftriaxone (Rocephin) 125 mg IM (drug of choice for
pregnant women)
Ofloxacin (Floxin) 400 mg orally
Treat concurrently with Doxycycline or Azithromycin
for 50% infected w/ Chlamydia
Ophthalmic ointment is routinely given as Crede’s
prophylaxis to prevent opthalmia neonatorum
(0.5% Erythromycin or 1% Tetracycline ointment for
newborn babies)
Nursing interventions
Health Teachings:
Avoid sexual intercourse until cured of the
infection or use condom to prevent
transmitting the infection.
Examination and treatment of sexual
partner to prevent reinfection is necessary.
Return to clinic for check-up in 4 to 7 days
after completion of treatment.
Monitor treatment
SYPHILIS
Tertiary - gumma
PRIMARY
SECONDARY
TERTIARY
Diagnosis
VDRL (venereal disease research laboratory test) or RPR
(rapid plasmin reagin) – nonspecific tests
- for screening and to follow treatment course (decrease
fourfold in 3-6 months)
Fluorescent Treponemal Antibody AbsorptionTest
(FTA-ABS) or Microhemagglutination Assay for Antibodies to
TP (MHA-TP)– specific tests for syphilis
Dark-field microscopic examination of lesion- 1st and 2nd
stage
Management
Primary and secondary and early latent disease - Pen
G (Benzathine Penicillin G 2.4 M U IM)
Complications
Congenital syphilis in newborn if untreated in late
pregnancy
Late abortion
Stillbirth
Health Teachings :
Educate women to recognize signs of syphilis.
Educate women to seek immediate treatment if known
exposure occurs.
Encourage women to wear cotton underwear.
Use condom during intercourse.
Sexual partners must also be treated to prevent re-
infection.
No sexual intercourse until lesions disappear
After completion of treatment, the woman is treated
monthly & the sexual partner at 3 months, 6 mos & 12
mos.
Diagnosis
Viral culture
Pap smear (shows cellular changes)
Tzanck smear (scraping of ulcer for staining) –
multinucleated giant cells
Management
Antiviral agents – Acyclovir
200 mg PO q 4 hrs for 5
days
Sitz bath
Analgesics
Health teachings
Complications:
• NO sexual activity in the
Meningitis
presence of lesions and 10-14
Neonatal infection (vaginal days after lesions subsided
birth) • Keep vulva clean and dry in
Trigeminal herpes zoster the presence of lesions
(facial muscle paralysis) (wearing of cotton underwear)
• Sitz bath
Genital warts
Genital or venereal warts caused by Human Papilloma Virus
(HPV)
May be a precursor to cervical cancer
Management
Small lesions – treated
topically with podophyllin or
trichloroacetic acid
Larger lesions – ablated with
cryotherapy, laser
Complications vaporization or surgical
•Neoplasia excision.
•Neonatal laryngeal Recurrence rate : 20%
papillomatosis
(vaginal birth)
Health Teachings
Inform the patient that infection with the virus increases
the incidence of CERVICAL CANCER
Therefore: Annual PAP smear is indicated
Pelvic Inflammatory Disease
Caused by microorganisms colonizing
endocervix ascending to endometrium and
fallopian tubes
Due to sexually transmitted microorganisms
ie Neisseria, Chlamydia, Haemophilus
influenza, streptococci
Risk Factors
Multiple sexual partners
History of PID
Early onset sexual activity
Recent gyne procedure
IUD
Manifestations
pelvic pain – sharp and cramping
Fever
Excessive vaginal discharge
Menorrhagia
Metrorrhagia
Urinary symptoms
Cervical uterine tenderness with movement
Diagnostics
History and PE
CBC
Vaginal and endocervical culture
VDRL
Endometrial biopsy - endometritis
Sonography – tubo-ovarian abscess
Laparoscopy - salpingitis
Management
Antibiotics
IV fluids/increase oral fluid
Pain medications
Remove IUD
Evaluation of sexual partners
Toxic Shock syndrome
Reproductive age, near menses or postpartum period
D/t S. Aureus
R/t use of tampons, cervical cap or diaphragm
Management:
IV fluids
Antibiotics
renal dialysis
Client education – change tampons 3-6 hours, avoid
tampons 6-8 wks after childbirth, do not leave
diaphragms>48 hours
PMS
PREMENSTRUAL SYNDROME
(PMS)
it has such a wide variety of signs and
symptoms.
Mood swings, tender breasts, food cravings,
fatigue, bloatedness, irritability and depression
are among the most common symptoms of PMS.
Occurs during the 7-10 days before menstruation
and disappear few hours after the onset of
menstrual flow
PREMENSTRUAL
SYNDROME (PMS)
CAUSES
Unknown
Fluctuation in estrogen and
progesteron
PMS
Treatment
Symptomatic relief
Tranquilizer as prescribed
Dietary changes : increasing protein,
decreasing sugar + vitamin B complex
counseling
DYSMENORRHEA
Dysmenorrhea
Secondary dysmenorrhea
most often endometriosis
pelvic inflammatory disease (PID)
uterine fibroids
abnormal pregnancy (i.e., miscarriage, ectopic)
infection, tumors, or polyps in the pelvic cavity
Who is at risk for dysmenorrhea?
Diagnostics:
laparoscopy
Management:
No menstrual period
Primary amenorrhea. You have no menstrual
period by age 16.
Secondary amenorrhea. You have no periods for
three to six months or longer.
Depending on the cause of amenorrhea,
milky nipple discharge
headache
vision changes
excessive hair growth on your face and torso (hirsutism).
Causes
Primary amenorrhea
Affects less than 1 percent of adolescent girls
The most common causes of primary
amenorrhea include:
1. Chromosomal abnormalities.
2. Problems with the hypothalamus.
Functional hypothalamic amenorrhea is a disorder of the
hypothalamus — an area at the base of the brain that acts
as a control center for the body and regulates the menstrual
cycle.
Excessive exercise, eating disorders, such as anorexia, and
physical or psychological stress can all contribute to a
disruption in the normal function of the hypothalamus.
Less commonly, a tumor may prevent your hypothalamus
from functioning normally.
Causes
Primary amenorrhea
.
Breast-feeding. Mothers who breast-feed often
experience amenorrhea. Although ovulation may
occur, menstruation may not. Pregnancy can
result despite the lack of menstruation.
Stress. Mental stress can temporarily alter the
functioning of your hypothalamus —Ovulation and
menstruation may stop as a result. Regular
menstrual periods usually resume after your
stress decreases.
Causes : Secondary amenorrhea
.
Medication. antidepressants, antipsychotics, some
chemotherapy drugs and oral corticosteroids
Pituitary tumor.
A noncancerous (benign) tumor in the pituitary gland
(adenoma or prolactinoma) can cause an overproduction
of prolactin. Excess prolactin can interfere with the
regulation of menstruation. This type of tumor is treatable
with medication, but it sometimes requires surgery.
Uterine scarring.
Asherman's syndrome, a condition in which scar tissue
builds up in the lining of the uterus,
occur after uterine procedures, such as a dilation and
curettage (D and C)
Caesarean section or treatment for uterine fibroids.
Uterine scarring prevents the normal buildup and
shedding of the uterine lining, which can result in very
light menstrual bleeding or no periods at all.
Causes : Secondary amenorrhea
Premature menopause.
Menopause usually occurs between ages 45
and 55.
If menopause before age 40, premature.
The lack of ovarian function associated with
menopause decreases the amount of circulating
estrogen in the body, which in turn thins the
uterine lining (endometrium) and brings an end to
the menstrual periods.
Premature menopause may result from genetic
factors or autoimmune disease, but often no
cause can be found.
Nursing care
Patient education
For primary or secondary amenorrhea, consult :
never had a menstrual period, and you're age 16
or older
previously menstruated, but have missed three or
more periods in a row
Tests and diagnosis
Blood tests
hormone levels,
thyroid function test or evaluation of prolactin level.
A progestin challenge test — in which they take a hormonal
medication (progesteron) for seven to 10 days to trigger bleeding
Imaging tests
computerized tomography
magnetic resonance imaging
ultrasound, can reveal pituitary tumors or structural
abnormalities in your reproductive organs.
laparoscopy or hysteroscopy — minimally invasive surgical
techniques to view the internal organs — may sometimes be
recommended.
Nursing care
if any — depends on what's causing the
amenorrhea.
suggest that they make changes to their lifestyle
depending on their weight, physical activity or
stress level.
If with PCOS or athletic amenorrhea, may
prescribe oral contraceptives to treat the
problem.
Amenorrhea caused by thyroid or pituitary
disorders may be treated with medications.
DYSFUNCTIONAL UTERINE
BLEEDING ( DUB)
is the most common cause of abnormal
vaginal bleeding during a woman's
reproductive years.
The diagnosis of DUB should be used only
when other organic and structural causes
for abnormal vaginal bleeding have been
ruled out.
AUB- diagnosis referring to any uterine
bleeding that is irregular in amount,
duration, or timing
DUB- most common type of AUB and is
frequently defined as irregular uterine bleeding
unrelated to organic pathology, medication,
pregnancy related disorders, systemic condition,
causes of AUB:
1. pregnancy-ectopic, spontaneos abortion
2.endocrine problem- cushing
syndrome,diabetes
3.medication-
amphetamines,anticoagulants,steroids,INH,SS
RIs
4. systemic dse.- thyroid
dysfunction,leukemia,ITP
Types:
1.anovulatory DUB- due to lack of progesterone in
the luteal phase of anovulatory cycles leads to
unstable ,excessively vascular endometrium, often lead
to abnormal cycle interval, or abnormal amount of
bleeding
2. ovulatory DUB- are regular and tend to be
cyclic,although the bleeding pattern are often
abnormal,menorrhagia is commonly observed and is
commonly associated with pelvic pathology
Causes of anovulation:
Physiologic:
Pregnancy
Lactation
Perimenarche
Perimenopause
Pathologic causes:
Hyperandrogenic disorder
Hyperprolactinemia
Extreme stress
s/sx: uterine bleeding
Physical Examination:
1. pelvic examination
2.Speculum examination
3. bimanual examination
Management:Goal:1. normalize the
bleeding
2. correct any anemia
3. restore quality of life
4.prevent cancer
1. medication – oral contraceptives
2. surgery- D and C, Hysterectomy
Management
pelvic ultrasonography.
Transvaginal ultrasonography (TVUS): if the
patient may be pregnant or may have anatomic
problems or polycystic ovarian syndrome.
Narrow vaginal
Hymen
Psychological disorders
Anxiety
Vaginismus
Endometriosis
Hemorrhoids
CAUSES Dyspareunia
Pelvic infection
Pelvic inflammatory disease
Genital tract tumor
Vaginal tumors
Vaginal surgery
Pelvic disorders
Sexual organ disorders
Some causes of deep penetration intercourse pain in women
include:
Pelvic inflammatory disease
Pelvic tumor
Irritable bowel syndrome
MANAGEMENT Dyspareunia
History and physical examination with pelvic and rectal
exams
–Timing: Onset (e.g., upon entry, after intercourse), duration,
persistence after intercourse, prior occurrence(s)
–Associations: Symptoms may occur with all vaginal or vulvar
contact, with intercourse only, with exams only, with
masturbation, or with memories or recollections of prior
occurrences or traumatic experiences
–Alleviating and aggregating factors during intercourse
–Qualifiers: Burning, sharp, dull, aching, throbbing, stabbing
–Include complete psychiatric history and exam
Dyspareunia
Routine studies include a CBC, sedimentation
rate, urinalysis, urine culture and sensitivity, and
vaginal smear and culture.
A Pap smear should also be done.
If pregnancy is suspected, a pregnancy test
should be done.
If there is a pelvic mass, pelvic ultrasound may be
helpful.
MANAGEMENT Dyspareunia
Imaging studies
pelvic and/or abdominal ultrasound and/or CT
scan
Management of psychiatric causes is
particularly challenging and requires
specific and specialized therapy
Consider gynecology and/or psychiatry
consult
TREATMENT Dyspareunia
Treatment varies depending on
etiology
Psychological causes may require counseling
with behavioral feedback and/or pharmacological
treatment
Symptoms refractory to initial treatment of proper
duration require prompt reconsideration and
further workup
Referral may be necessary for specialized cases
or cases with psychiatric components
Vaginismus:
Vaginal entrance muscle spasms triggered
by sex
Involuntary contraction of muscle at the
outlet of the vagina when coitus is
attempted prohibiting penile penetration.
CAUSES
1. Fear of sex
2. Unpleasant sexual experience
3. Negative attitude to sex
TREATMENT
PSYCHOLOGICAL COUNSELLING
Prognosis of Vaginismus
Most women recover to normal sex
life and motherhood with treatment.
SEXUAL
DYSFUNCTION IN
MALE
Erectile dysfunction
impotence
Erectile dysfunction ( impotence)
Inability of the man to produce or maintain
erection , long enough for vaginal
penetration or partner satisfaction.
Formerly called impotence
Causes:
Erectile dysfunction ( impotence)
Physical cause
Common causes of erectile dysfunction
include:
Heart disease
Clogged blood vessels (atherosclerosis)
High blood pressure
Diabetes
Obesity
Metabolic syndrome
Causes:
Erectile dysfunction ( impotence)
Other causes of erectile dysfunction include:
Certain prescription medications -antidepressants,
antihistamines and medications to treat high blood
pressure, pain and prostate cancer
Tobacco use
Alcoholism and other forms of drug abuse
Treatments for prostate cancer
Parkinson's disease
Multiple sclerosis
Hormonal disorders such as low testosterone
(hypogonadism)
Surgeries or injuries that affect the pelvic area or spinal
cord
Psychological causes of erectile
dysfunction
Depression
Anxiety
Stress
Fatigue
Poor communication or conflict with your partner
Ultrasound. This test can check blood flow to your penis.
Neurological evaluation.
Dynamic infusion cavernosometry and cavernosography
(DICC).
This procedure involves injecting a dye into penile blood
vessels to permit view any possible abnormalities in blood
pressure and flow into and out of your penis. It's generally done
with local anesthesia by a urologist who specializes in erectile
dysfunction.
Nocturnal tumescence test.
A simple test that involves wrapping a special perforated tape
around the penis before going to sleep can confirm whether you
have erections while you're sleeping. If the tape is separated in
the morning, your penis was erect at some time during the
night. Tests of this type confirm that there is not a physical
abnormality causing erectile dysfunction, and that the cause is
likely psychological.
Oral medications
Oral medications available to treat ED include:
Sildenafil (Viagra)
Tadalafil (Cialis)
Vardenafil (Levitra)
ACTION :
Chemically known as phosphodiesterase inhibitors, these
drugs enhance the effects of nitric oxide, a chemical that
relaxes muscles in the penis. This increases the amount
of blood flow and allows a natural sequence to occur —
an erection in response to sexual stimulation.
Hormone replacement therapy
For the small number of men who have testosterone deficiency,
testosterone replacement therapy may be an option.
Penis pumps
This treatment involves the use of a hollow tube with a hand-powered or
battery-powered pump. The tube is placed over the penis, pump is used to
suck out the air. This creates a vacuum that pulls blood into the penis.
Once you achieve an adequate erection, slip a tension ring around the
base of the penis to maintain the erection. then remove the vacuum device.
The erection typically lasts long enough for a couple to have sex. remove
the tension ring after intercourse.
Vascular surgery
This treatment is usually reserved for men whose blood flow has
been blocked by an injury to the penis or pelvic area.
The goal of this treatment is to correct a blockage of blood flow to the penis
so that erections can occur naturally. But the long-term success of this
surgery is unclear.
Penile pump
Penis pump
Penile implants
The inflatable device allows to control when and how long
you have an erection, These implants consist of either an
inflatable device or semirigid rods made from silicone or
polyurethane. This treatment is often expensive and is
usually not recommended until other methods have been
considered or tried first. As with any surgery, there is a small
risk of complications such as infection.
Psychological counseling and sex therapy
SURGICAL MANAGEMENT
Hymen incision
CONGENITAL ABSENCE
OF THE VAGINA
CONGENITAL ABSENCE OF THE
VAGINA
Imaging studies
UTZ
MRI
Laparoscopy provides only indirect assessment of uterine
cavitation.
Laparoscopy is the preferred procedure when uterine
remnants or endometriosis cause cyclic pelvic pain
requiring excision.
Pyelography: Perform intravenous pyelography to assess
renal structure.
Radiography: Perform spinal radiography to exclude
vertebral anomalies
Management
Treatment : Surgical
Vaginal reconstruction
modified McIndoe vaginoplasty
Prognosis:
The patient may have normal sexual functioning
after surgical reconstruction.
Surgical reconstruction does not establish the
ability to conceive through natural means.
modified McIndoe vaginoplasty
DOUBLE / SEPTATE
VAGINA
vaginal septum is a congenital
partition within the vagina; such a
septum could be either longitudinal
or transverse.
Treatment
ECTOPIC PREGNANCY
miscarriage in 37%
preterm birth in 16%,
term birth in only 45%.
MANAGEMENT
hysterosalpingogram (HSG)
hysteroscopy
but diagnosis should be confirmed with a
three-dimensional ultrasound or
laparoscopy.
Risk
preterm labor
cervical insufficiency
many women with bicornuate uteri carry
pregnancies to full term without any
problems, so the risk may vary for each
woman.
Management
reconstructive laparoscopic
cervical cerclage, a stitch placed in the
cervix to stop premature dilation
Double uterus
Definition
In a female fetus, the uterus starts out as
two small tubes. As the fetus develops, the
tubes normally join to create one larger,
hollow organ the uterus. Sometimes,
however, the tubes don't join completely.
Instead, each one develops into a separate
cavity. This condition is called double
uterus (uterus didelphys).
Double uterus
Each cavity in a double uterus often leads to its own cervix.
Some women with a double uterus also have a duplicate or
divided vagina.
Double uterus is rare — and sometimes not even diagnosed.
occurs in 2 %t to 4 % of women who have normal
pregnancies.
The percentage may be higher in women with a history of
miscarriage or premature birth.
Treatment is needed only if a double uterus causes
symptoms or complications, such as pelvic pain or repeated
miscarriages.
Symptoms
Unknown .
The condition is associated with kidney
abnormalities, which suggests that
something may influence the development
of these related tubes before birth.
Tests and diagnosis
Prevention
pelvic floor exercises
avoid chronic constipation and straining
estrogen therapy
Conservative
pessaries (ring)
replace prolapse to reduce edema and cure ulceration
Surgical measures
Vaginal
Vaginal hysterectomy + Pelvic Floor Repair
Manchester [Fothergill] Repair + Pelvic Floor Repair
Le Fort’s operation
Abdominal: Total abdominal hysterectomy & repair of
enterocoele [usually will also require vaginal repair].
Enterocoele
Nursing care
well- ordered hygienic mode of living
a nutritious and bland diet
adequate mental and physical rest
daily exercise , agreeable, occupation, fresh air
regular hours of eating and sleeping
regulation of the bowels and wholesome
companionship with others.
Nabothian cyst
Common findings
is a mucus-filled cyst on the surface of the uterine cervix.
appear most often as firm bumps on the cervix's surface. A
woman may notice the cyst when inserting a diaphragm or
cervical cap, or when doing the cervix check as part of fertility
awareness
Cause is unknown
Diagnosis is made clinically
There are no symptoms
are not considered problematic unless they grow very large
and present secondary symptoms
Treatment: no treatment
Cervical polyps
Are a result of benign hyperplasia of the glandular tissue
arising from the mucosa
Causes: unknown
most often occur in women older than 20 who have had
several pregnancies
Symptoms : abnormal vaginal bleeding
Between menstrual periods.
After menopause.
After sexual intercourse.
After douching.
myomectomy
Benign Ovarian masses
Ovarian cysts – physiologic variations in
menstrual cycle
Dermoid cysts - (cystic teratomas) –
cartilage, bone, teeth, skin or hair can be
observed
Endometriomas (chocolate cysts)
Manifestations
Benign Ovarian masses
Sensation of fullness, cramping, dyspareunia,
irregular bleeding
Diagnostics:
USG
Management:
OCP to suppress ovarian function
surgery
Leiomyoma
Fibroid tumors
40 yrs old
Potential for cancer is minimal
Smooth muscle cells present in whorls and
arise from uterine muscle
Manifestations
Frequently asymptomatic
Lower abdominal pain
Fullness or pressure
Menorrhagia
Metrorhaggia
dysmenorrhea
Diagnostics: USG
Management:
Routine pelvic exam every 3-6 months
surgery
Vaginal Cancer
Upper 1/3 most common site
S/S: painless vaginal bleeding and discharge,
urinary retention, bladder spasm, hematuria,
frequency of urination, tenesmus, constipation,
blood in the stool
Dx: pap smear, biopsy
Mx: radiation, surgery
Cervical Ca
Preventable
Risk Factors:
coitus at an early age
Multiple sexual partners
Sex partner w/ a hx of numerous sexual partners
Exposure to STD
HPV infections
Chemotherapy
Contraceptive use>5 yrs
Smoking
Antenatal exposure to DES
History of dysplasia
Diagnostics:
Pap smear
Colposcopy
Endocervical curettage
Management:
surgery
Colposcopy is performed with
the woman lying on her back,
legs in stirrups, and buttocks
at the lower edge of the table
(a position known as the
dorsal lithotomy position).
A speculum is
placed in the vagina after the
vulva is examined for any
suspicious lesions .
Three percent acetic acid is applied to
the cervix using cotton swabs
Areas of the cervix which turn white
after the application of acetic acid or
have an abnormal vascular pattern are
often considered for biopsy. If no
lesions are visible, an iodine solution
may be applied to the cervix to help
highlight areas of abnormality
Endometrial Ca
Postmenopausal
Risk Factors:
1. Obesity
2. Multiparity
3. DM
4. HPN
5. Use of unopposed estrogen
6. High fat diet
7. Early menarche and late menopause
8. Use of Tamoxifen- is an orally active selective estrogen
receptor modulator (SERM). decreases DNA synthesis
and inhibits estrogen effects. it acts as partial agonist
on the endometrium
Manifestations:
Unusual bleeding, spotting, or other discharge
abnormal vaginal bleeding such as bleeding between
periods or after menopause
In about 10% of cases, the discharge associated with
endometrial cancer is not bloody
Pelvic pain and/or mass and weight loss
Diagnosis:
Pap smear
Endometrial biopsy
USG
Management:
TAHBSO
counseling
Stage Characteristics
Management: surgery
-End -
You better live your best and act your
best and think your best today,
For today, is the sure preparation for
tomorrows that follow
-Matineau-