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Flashcards in New Women's Health Deck (10):
1

Health History and Clinical Manifestations

Menstrual History, Pregnancies- when they started having babies, When they started Menses
Sexual History- when they started, how many partners
Genital Mutilation:
Male
- Piercing
- Circumcision
- Castration
Female
- Circumcision (cultural thing)
- Piercing
- Place material inside the vagina
Domestic Violence: Rape
Incest and Childhood Sexual Abuse

Rape and Sexual Assault:
We want to collect any forensics that we can
Oral
Anal
Vaginal
Semen
Trauma
Saliva
Fingernails
Hair

Health Issues of Women with Disabilities: Need to get them to the doctor

Lesbian Health:
Often underused the system so they aren’t judged
Not necessarily at lower risk for STDs
Smoke, drink,
Higher risk for ovarian, heart, breast cancer, lung disease

2

Physical Assessment

Positioning- lithotomy
Inspection
Speculum Examination
Bimanual Palpation:
- Cervix
- Uterus
- Adnexal
- Vaginal and rectal

3

Diagnostic Evaluation

Cytologic Test for Cancer- Pap Smear
- Bethesda System- The Bethesda system is a system for reporting cervical or vaginal cytologic diagnoses, used for reporting Pap smear results.
- Recorded as atypical cells and you need a biopsy

- Colposcopy and Cervical Biopsy
- Cryotherapy and Laser Therapy-
- Cone Biopsy- use knife twist to get a biopsy shape of a cone and LEEP (loop electrocervial excision procedure)- uses a wire loop heated by electric current to remove cells and tissue in a woman's lower genital tract.
- Endometrial (Aspiration) Biopsy- suction endometrial tissue, hurts really badly
- Dilatation and Curettage
- Endoscopic Examinations- laparoscopy, historoscopy
- Other – MRI, ultrasound, CT, histosalpingogram- looks for patency, any kind of lumps or bumps, will have 2-3 xrays afterwards, may have referred pain (usually shoulder pain- also associated with ectopic pregnancy)
- Pap smear- If you have cancer, you want it. Up to your doctor when you have it.

4

Menstrual Problems

Premenstrual Syndrome (PMS):
- Usually occurs 1 wk to several days prior
- S/S – HA, fatigue, low back & breast pain, bloating, irritability, mood swings, binge eating, crying, fear of losing control, short term memory loss
- TX – Meds such as SRIs, prostaglandin inhibitors, diuretics, progesterone meds, OTC meds- pamprin or midol, vitamins and minerals- vitamin B
- 3 elements: do a diary: severity, symptoms and timing

Dysmenorrhea – Painful periods, “cramps”
Primary
- Normal physical exam
- Result of excessive production of prostaglandins
- Contributing factors – anxiety, tension
Secondary
- Pelvic pathology- endomitritis, thyroid, infection
- S/S may occur days before period, at ovulation, and with intercourse
- TX- NSAIDS, ASA, low dose contraceptives. Local heat, increased physical exercise, yoga, acupuncture

Amenorrhea – Absence of periods
Primary – delayed menarche
- Over 16 with secondary sexual characteristics
- Over 14 with no secondary charteristics
- Maybe missing uterus or overies
- Maybe obstruction or blockage
- Usually due to body build, heredity, environment, physical, mental and emotional development
Secondary – missed 3 cycles or 6 months
- Cause – pregnancy, stress, nutritional disturbances, athletics, pituitary and thyroid dysfunction, ovarian problems- cysts of ovary (polycystic ovaries)- grow facial hair, heavy set

Abnormal Uterine Bleeding –irregular, painless endometrial bleeding that may be excessive, prolonged, or without pattern
- Anovulatory- ovulation does not occur
- Usually occurs in teens and perimenopausal women
- Can be related to cysts, obesity, hypothalmic dysfunction
- Could be manifestation of life-threatening disorder
- Diagnostics: D&C, Progesterone ordered


Menorrhagia – prolonged/excessive regular period
- Early – endocrine prob,
- Later-- inflammatory prob, uterine tumors, hormonal prob,
Cyst, obesity, hypothalamic problem
- PC = anemia

Metorrhagia – bleeding between periods
- Could be cancer, benign tumors or other gyn problems
- If on hormones needs evaluation
- Menometorrhagia – heavy bleeding during and between periods

Postmenopausal bleeding – Bleeding 1 year after no periods
- Needs investigation – D&C, Endometrial biopsy
- 20-30% have cancer

5

Vulvovaginal Infections

Candidiasis- yeast infection. Can go systemic. Loves sugar so common in diabetics.

Seminal Plasma Protein Allergy- allergic to semen

Bacterial Vaginosis

Trichomoniasis- grey foul smelling discharge, itches. Treat with antifungal (flagil), must treat partner also

Human Papillomavirus – can cause cancer, see warts

Herpes virus, Type 2 Infection- open sores on genitalia, can still pass it if you are not sexually active, should not have intercourse while being treated

Toxic Shock Syndrome- Staph infection, kills you. Get a macular rash like a sunburn, start to peel, respiratory distress/arrest, DIC, lung problems. Leaving tampons in for too long

Endocervicitis and Cervicitis

Chlamydia and Gonorrhea

Pelvic Infection (PID)- can go into sepsis, dysparunia- pain within uterus, a lot of pain with voiding and defecating, tired, anorexic, NV, Tx: antibiotics,

HIV

6

Structural Disorders

Fistulas- hole between 2 tubes

Pelvic Organ Prolapse

Cystocele- bladder comes through front

Rectocele- bladder comes through back

Enterocele- small intestine and peritoneal through front

Uterine Prolapse- uterus through vagina
- Causes: Multiple babies
- Prevention: hormonal therapy- keeps the vagina more in shape (should be on estrogen and progesterone), kegal exercises
- Treatment: can wear a pesarri (Hold everything in place, Fitted to your vagina, May have an increase in discharge, UTIs, vaginosis, odor) no jumping, running, smoking, can shove it back up,
- Grade 1: comes down when you push
- Grade 2: can see from the outside
- Grade 3: comes out

Treatment: suspend the bladder, suspend the urethra, plastic surgery to tighten the vagina
* Must makes sure they don’t get constipated: stool softener, raisen bran, prune juice, walking, water

7

Benign Disorders

Vulvitis- vulva is itcy- often because of diabetes

Vulvar Cysts- will probably have to be lanced

Vulvar Dystrophy- lykin sclerosis, itch and eventually scratch so much that you build a lump, use steroid cream to heal, can get heavy bleeding, often in elderly

Ovarian Cysts- stay on the overy, can pop and then go away, very painful. usually fluid filled, sometimes blood fills, some pop

Benign Tumors

Fibroids- if it’s in a muscle, muscle can’t clamp down, will probably bleed heavier for a longer period of time. Can do a myomectomy or a hysterectomy. May give alcohol injection into the area

polyps- abnormal bleeding, D&C, can scrape it off, rarely come back, can be precancerous.

Polycystic overies- endocrine problem, multiple cysts, overweight, hairy, a lot of acne, irregular in periods, may have fertility problems, at risk for CAD, hypertension, cancer, diabetes


Drugs: Lupron (hot flashes)
Endometriosis
Adenomyosis- a gynecologic medical condition characterized by the abnormal presence of endometrial tissue within the myometrium.

8

Endometriosis

Slow progressive condition -usual age 20-30

Patho-
- Cause unknown – transported and disseminated by the vascular and/or lymphatic system
- Endometrial tissue grows outside the uterus into peritoneal area
- Responds to hormonal stimuli- will build up with progesterone during menses, will start to bleed inside of your belly and it will spread
- Can attach itself to the lung, kidneys, bowel, anything in the peritoneal area
- Can cause strictures
- Goes thru same cyclic changes as uterus
- Bleeds, blood trapped in tissues – reabsorbed
- Reabsorption causes adhesions

Resolves with pregnancy, oophorectomy (surgical removal of one or both ovaries), menopause

S/S
Lower abdominal pain
Rectal pressure
Dysparunia- pain with intercourse
Hypermenorrhea- excessive, heavy flow
Exam – pelvic tenderness, fixed uterus, nodular uterosacral ligaments

Tx –
Medications- Nsaids, oral contraceptives, Danozol/Danocrine- stops all ovarian action (hot flashes, depression, fatigue), ovarian suppressing hormones, hormone agonists
Surgery –oophorectomy, ablations, surg removal of tissue

Down to it: Misplaced uterine cells, bleeds with no outlet, not hereditary, 25-35 no children, depression, relationship problems because intercourse hurts

9

Infertility

unable to conceive after 1 year of unprotected sex
Female - Anovulatory, uterine/cervical factors, blocked tubes, endometriosis
Male – sperm quality or quantity
Testing is extensive
Wearing on the relationship
Medical Management:
- Surgery, medications, artificial insemination, invitro fertilization, intracytoplasmic injection

10

Menopause

Normal part of aging and maturation
Menses stops
Ovaries no longer active
No ovarian hormones
Decrease in estrogen
- Vasomotor instability –hormonal fluctuations
- Bone formation decreased- more at risk for fractures
- Vaginal lubrication decreased
- Thinning of genitourinary tissue
- Increased ph of vagina
- Prolapsing organs
- Thin pubic hair
- More body fat
- Decrease libido

Management:
Hormone Replacement Therapy
- ***Need combo of progesterone and estrogen
- Can be: Oral, Transdermal, IM, ID
- Advantages: Gets rid of hot flashes
Disadvantages: Problems with Gallbladder, Breast cancer, Endomitrian cancer, Bloating, Nausea

- Alternative Medications
- Behavioral strategies
- Self-esteem
- Nutrition: Low fat, High fiber
- High calcium – 1500mg a day
- Weight bearing exercise

***Should only take estrogen for as long as hot flashes are overbearing and then stop.
OVARIAN CANCER FIRST SIGN: BLOATING