Chapter 4

Reproductive System
Concerns
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Amenorrhea
Primary
Anatomic
Endocrine
Chronic disease
Eating disorders
Medications
Secondary
Most often result of pregnancy
A clinical sign of a variety of disorders

Menstrual Disorders
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Hypogonadotropic amenorrhea
Problem in central hypothalamic-pituitary axis
Results from hypothalamic suppression
Management
Counseling and education regarding stress, exercise,
and weight loss
Calcium, vitamin D

Menstrual Disorders (Cont.)
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Dysmenorrhea
Pain during or shortly before menstruation
Primary dysmenorrhea
Biochemical basis
Arises from the release of prostaglandins
Abnormally increased uterine activity
Alleviating discomfort
Medications
Heat
Alternative modalities
Menstrual Disorders (Cont.)
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Dysmenorrhea
Secondary dysmenorrhea
Acquired menstrual pain associated with pelvic pathology
Diagnosis and treatment
Pelvic examination
Ultrasound examination, dilation and curettage, endometrial
biopsy, laparoscopy
Treatment directed to removal of underlying pathology
Menstrual Disorders (Cont.)
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Premenstrual syndrome (PMS)
Cyclic symptoms occurring in luteal phase of
menstrual cycle
PMS
Cluster of physical, psychologic, and behavioral symptoms
Poorly understood
30% to 80% of women experience symptoms
Treatment includes diet, exercise, and herbal therapies
Menstrual Disorders (Cont.)
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Premenstrual dysphoric disorder (PMDD)
Cyclic symptoms occurring in the last 7 to 10 days of
the menstrual cycle
PMDD
Severe variant of PMS with emphasis on mood affectation
Affects 3% to 8% of women
Treatment similar to that for PMS; plus may warrant counseling,
medications, and alternative therapies, such as hypnosis and
acupuncture

Menstrual Disorders (Cont.)
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Endometriosis
Presence and growth of endometrial tissue outside of
uterus
Major symptoms
Dysmenorrhea
Deep pelvic dyspareunia (painful intercourse)
Treatment
Drug therapy
Surgical intervention
Menstrual Disorders (Cont.)
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Alterations in cyclic bleeding
Oligomenorrhea and hypomenorrhea
Menorrhagia (hypermenorrhea)
Metrorrhagia
Abnormal uterine bleeding
Dysfunctional uterine bleeding


Menstrual Disorders (Cont.)
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Sexually transmitted infections (STIs)
Includes more than 25 infectious organisms
transmitted sexually
19 million people affected annually in the U.S.
Prevention
Primary
Secondary

Infections
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STIs/HIV prevention strategies
Safer sex practices
Knowledge of partner, reducing partners
Low-risk sex
Condom use
Vaccination

Infections (Cont.)
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Sexually transmitted bacterial infections
Chlamydia
Most frequently reported STI
Infections often silent and highly destructive
Difficult to diagnose
Screening and diagnosis
Screening of asymptomatic and pregnant women
Comparisons of diagnostic procedures
Management
Drug therapy
Infections (Cont.)
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Sexually transmitted bacterial infections
Gonorrhea Neisseria gonorrhoeae
Oldest communicable disease
Aerobic and gram-negative diplococci
Screening and diagnosis
Women are often asymptomatic
Management
Treatment with antibiotic therapy
Drug-resistant strains on the rise
Infections (Cont.)
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Sexually transmitted bacterial infections
Syphilis - Treponema pallidum, a motile spirochete
Transmission by entry in subcutaneous tissue through
microscopic abrasions
Transplacental transmission may occur at any time during
pregnancy
Infection manifests itself in distinct stages
Primary: 5 to 90 days
Secondary: 6 weeks to 6 months


Infections (Cont.)
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Sexually transmitted bacterial infections
Syphilis
Screening and diagnosis
Pregnant women
Serologic tests
False positives
Management
Penicillin
Sexual abstinence during treatment
Infections (Cont.)
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Sexually transmitted bacterial infections
Pelvic inflammatory disease (PID)
Results from ascending spread of microorganisms from
vagina and endocervix to upper genital tract
Caused by multiple organisms
Most commonly involves:
Uterine tubes (salpingitis)
Uterus (endometriosis)
Infections (Cont.)
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Sexually transmitted bacterial infections
PID
At increased risk for:
Ectopic pregnancy
Infertility
Chronic pelvic pain
Symptoms depend on type of infections:
Acute
Subacute
Chronic
Infections (Cont.)
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Sexually transmitted bacterial infections
PID
Screening and diagnosis
History
CDC routine criteria
Management
Prevention
Oral or parenteral therapy
Bedrest
Education
Infections (cont.)
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Sexually transmitted viral infections
Human papillomavirus (HPV)
Most prevalent viral STI seen in ambulatory health care
settings
Genital warts
More common in pregnant women
Symptoms
Irritating vaginal discharge with itching
Dyspareunia, postcoital bleeding

Infections (Cont.)
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Sexually transmitted viral infections
HPV
Screening and diagnosis
History of known exposure
Physical inspection
Pap smear
Management
No therapy has been show to eradicate
Medications for discomfort
Counseling and education
Infections (Cont.)
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Sexually transmitted viral infections
Herpes simplex virus (HSV)
Herpes simplex virus 1 (HSV-1)
Transmitted nonsexually
Herpes simplex virus 2 (HSV-2)
Transmitted sexually
Infections (Cont.)
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Sexually transmitted viral infections
HSV
Initial infection is characterized by multiple painful lesions,
fever, chills, malaise, and severe dysuria
Maternal infection can have adverse effects on both the mother
and fetus
Increased miscarriage rates during the first trimester
Association with cervical cancer has been observed

Prevention is critical!
Infections (Cont.)
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Sexually transmitted viral infections
Viral hepatitis
Hepatitis A virus (HAV)
Acquired primarily through fecal-oral route
Ingestion of contaminated food
Person to person contact
Vaccination is most effective means of preventing HAV
transmission
Infections (Cont.)
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Sexually transmitted viral infections
Viral hepatitis
Hepatitis B virus
Most threatening to fetus and neonate
Disease of liver; often a silent infection
Transmitted parenterally, perinatally, orally (rarely), and through
intimate contact
Vaccination series
Infections (Cont.)
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Sexually transmitted viral infections
Viral hepatitis
Hepatitis C virus
Most common blood-borne infection in United States
Risk factor for pregnant women is history of injecting
intravenous drugs
Currently there is no vaccine
Infections (Cont.)
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Sexually transmitted viral infections
Human immunodeficiency virus (HIV)
Heterosexual transmission now most common means of
transmission in women
Estimated that 23% of new infections occur in women
Transmission of HIV occurs primarily through exchange of
body fluids
Infections (Cont.)
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Sexually transmitted viral infections
HIV
Severe depression of cellular immune system associated
with HIV infection characterizes AIDS
Symptoms include fever, headache, night sweats, malaise,
generalized lymphadenopathy, myalgias, nausea, diarrhea,
weight loss, sore throat, and rash
Infections (Cont.)
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Sexually transmitted viral infections
HIV
Screening and diagnosis
Antibody testing
CDC advocates routine voluntary testing
Counseling for HIV testing
HIV testing offered early in pregnancy
Rapid testing preferred method
Perinatal transmission has decreased
Nurses must consider confidentiality and documentation
Infections (Cont.)
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Sexually transmitted viral infections
HIV management
Resources
Death and dying
Suicide prevention
Financial assistance
Legal advocacy
Prevention of transmission and receipt of contraceptive
information
Substance abuse programs
Infections (Cont.)
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Vaginal infections
Vaginitis
An infection caused by a microorganism
Also called abnormal vaginal discharge
Bacterial vaginosis syndrome in which normal
hydrogen peroxide-producing lactobacilli are replaced
with high concentrations of anaerobic bacteria
Associated with preterm labor and birth
Infections (Cont.)
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Vaginal infections
Candidiasis Candida albicans
Vulvovaginal candidiasis, or yeast infection, is second most
common type of vaginal infection
Predisposition
Antibiotic therapy
Diabetes
Pregnancy
Obesity
Diets high in refined sugars
Use of corticosteroids
Immunosuppressed states
Infections (Cont.)
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Vaginal infections
Candidiasis
Common symptoms
Vulvar
Vaginal pruritus
Screening and diagnosis
Physical examination
Vaginal pH
Management
Over-the-counter agents
Methods of comfort
Infections (Cont.)
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Vaginal infections
Trichomoniasis Trichomonas vaginalis
STIs
Common cause of vaginal infection
Screening and diagnosis
Specular examination
Pap smear
Management
Metronidazole or tinidazole orally in a single dose
Sexual transmission must be communicated to infected woman
Infections (Cont.)
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Vaginal infections
Group B streptococci
Associated with poor pregnancy outcomes
An important factor in neonatal morbidity and mortality
Screening at 35 to 37 weeks of gestation decreases risk
Infections (Cont.)
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Infection control measures essential to protect
care providers and prevent nosocomial infection
of patients, regardless of infectious agent
Risk for occupational transmission varies with
disease
Any risk warrants reasonable precautions
Standard Precautions
Infection Control
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Benign problems
Fibrocystic changes
Fibroadenoma
Nipple discharge
Mammary duct ectasia
Intraductal papilloma

Problems of the Breast
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Cancer of the breast
Incidence and etiologies
One in eight women
Risk increases with age
Prevention
Chemotherapy prevention
Screening
Mammography
Needle aspiration
Problems of the Breast (Cont.)
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Cancer of the breast
Medical management
Radiation
Adjuvant hormone therapy
Biologic targeted therapy
Chemotherapy

Problems of the Breast (Cont.)
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Cancer of the breast
Surgical management
Lumpectomy
Total simple mastectomy
Modified radical mastectomy
Radical mastectomy
Breast reconstruction






Problems of the Breast (Cont.)
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In helping a client manage premenstrual
syndrome (PMS), the nurse should:
recommend a diet with more body-building and
energy food, such as red meat and sugar.
suggest herbal therapies, yoga, and massage.
tell the client to push for medications from the
physician as soon as symptoms occur to lessen
their severity.
discourage the use of diuretics.

Question
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