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Assessment of theAssessment of the
Female Female Reproductive Reproductive SystemSystem
Assessment of theAssessment of the
Female Female Reproductive Reproductive SystemSystem
Female Reproductive SystemFemale Reproductive System
External genitalia: vulva, labia majora, External genitalia: vulva, labia majora, labia minora, clitoris, vestibule, labia minora, clitoris, vestibule, perineumperineum
Internal genitalia: vagina, uterus, Internal genitalia: vagina, uterus, corpus, cervix, fallopian tubes, ovariescorpus, cervix, fallopian tubes, ovaries
BreastsBreastsMenstruation and menopauseMenstruation and menopause
Assessment Techniques: Assessment Techniques: FemaleFemale
History: pain, bleeding, discharge, History: pain, bleeding, discharge, massesmasses
Physical assessmentPhysical assessmentBreast examinationBreast examinationAbdominal examinationAbdominal examinationExamination of the external genitaliaExamination of the external genitaliaPelvic examinationPelvic examinationBimanual examinationBimanual examinationRectovaginal examinationRectovaginal examination
Papanicolaou TestPapanicolaou Test
Client preparation for pap testClient preparation for pap testProcedureProcedureFollow-up careFollow-up care
Blood StudiesBlood Studies
Pituitary gonadotropinPituitary gonadotropinSteroid hormonesSteroid hormonesSerologic testsSerologic testsSyphilis detectionSyphilis detectionProstate-specific antigenProstate-specific antigen
Other StudiesOther Studies
Urinalysis for steroid hormonesUrinalysis for steroid hormonesWet preparation (smears)Wet preparation (smears)CulturesCulturesGeneral x-raysGeneral x-raysCT scans for reproductive system CT scans for reproductive system
disordersdisorders
(Continued)(Continued)
Other StudiesOther Studies (Continued)(Continued)
Hysterosalpingography: an x-ray of the Hysterosalpingography: an x-ray of the cervix, uterus, and fallopian tubes cervix, uterus, and fallopian tubes MammographyMammography
UltrasonographyUltrasonography Magnetic resonance imaging to scan for Magnetic resonance imaging to scan for
pelvic tumorspelvic tumors ColposcopyColposcopy LaparoscopyLaparoscopy HysteroscopyHysteroscopy Cervical biopsyCervical biopsy Endometrial biopsy and aspirationEndometrial biopsy and aspiration
Other Diagnostic TestsOther Diagnostic Tests
Needle biopsy of the prostateNeedle biopsy of the prostateSemen analysisSemen analysis
Interventions for Clients Interventions for Clients with Gynecologic with Gynecologic
ProblemsProblems
Primary DysmenorrheaPrimary Dysmenorrhea
One of the most common gynecologic One of the most common gynecologic problems, occurring most often in problems, occurring most often in women in their teens and early 20s.women in their teens and early 20s.
TreatmentTreatmentPostaglandin synthetase inhibitors, oral Postaglandin synthetase inhibitors, oral
contraceptivescontraceptivesComplementary and alternative therapyComplementary and alternative therapy
Premenstrual Syndrome Premenstrual Syndrome
A collection of symptoms that are A collection of symptoms that are cyclic in naturecyclic in nature
Diet therapyDiet therapyDrug therapy: mild potassium-sparing Drug therapy: mild potassium-sparing
diuretics, progesterone, bromocriptine diuretics, progesterone, bromocriptine mesylate, Sarafemmesylate, Sarafem
Amenorrhea Amenorrhea
Absence of menstrual periodsAbsence of menstrual periodsPrimary amenorrheaPrimary amenorrheaSecondary amenorrheaSecondary amenorrheaTreatment: hormone replacement, Treatment: hormone replacement,
ovulation stimulation, periodic ovulation stimulation, periodic progesterone withdrawalprogesterone withdrawal
Postmenopausal Bleeding Postmenopausal Bleeding
Manifestation (not disease)—vaginal Manifestation (not disease)—vaginal bleeding that occurs after a 12-month bleeding that occurs after a 12-month cessation of menses after the onset of cessation of menses after the onset of menopausemenopause
Atrophic vaginitisAtrophic vaginitis Endometrial hyperplasiaEndometrial hyperplasia Treatment: endometrial biopsy, Treatment: endometrial biopsy,
hysterectomy, hormonal replacement hysterectomy, hormonal replacement therapy, vaginal lubricantstherapy, vaginal lubricants
EndometriosisEndometriosis
Endometriosis is usually a benign Endometriosis is usually a benign problem of endometrial tissue problem of endometrial tissue implantation outside the uterine implantation outside the uterine cavity.cavity.
Manifestations include pain, Manifestations include pain, dyspareunia, painful defecation, dyspareunia, painful defecation, sacral backache, hypermenorrhea, sacral backache, hypermenorrhea, and infertility. and infertility.
Erythrocyte sedimentation rate and Erythrocyte sedimentation rate and white blood cell count rule out white blood cell count rule out pelvic inflammatory disease.pelvic inflammatory disease.
Laparoscopy is the key diagnostic Laparoscopy is the key diagnostic procedure.procedure.
Endometriosis: Endometriosis: Interventions Interventions
Drug therapyDrug therapyMild analgesics, nonsteroidal anti-Mild analgesics, nonsteroidal anti-
inflammatory drugs, hormonal inflammatory drugs, hormonal therapies, pseudopregnancy, therapies, pseudopregnancy, pseudomenopause, or medical pseudomenopause, or medical oophorectomyoophorectomy
Complementary and alternative therapyComplementary and alternative therapySurgical managementSurgical management
Dysfunctional Uterine Bleeding Dysfunctional Uterine Bleeding Nonspecific term to describe bleeding that is excessive or abnormal in Nonspecific term to describe bleeding that is excessive or abnormal in
amount or frequency without predisposing anatomic or systemic amount or frequency without predisposing anatomic or systemic conditionsconditions
Associated with:Associated with: Endocrine disturbancesEndocrine disturbances Polycystic ovary diseasePolycystic ovary disease Stress Stress Extreme weight changesExtreme weight changes Long-term drug useLong-term drug use Anatomic abnormalitiesAnatomic abnormalities
ManagementManagement Nonsurgical management includes hormone manipulation.Nonsurgical management includes hormone manipulation. Surgical management includes:Surgical management includes:
Dilation and curettage procedureDilation and curettage procedure Laser or balloon endometrial ablationLaser or balloon endometrial ablation Hysterectomy Hysterectomy
Menopause Menopause
Normal biologic event marked for most Normal biologic event marked for most women by the end of menstrual periods women by the end of menstrual periods (6 to 12 months of amenorrhea)(6 to 12 months of amenorrhea)
Role of hormone replacement therapy in Role of hormone replacement therapy in the management of symptomsthe management of symptoms
Perimenopause indicated by changes in Perimenopause indicated by changes in ovarian functionovarian function
Interventions, including hormone Interventions, including hormone replacement therapyreplacement therapy
Simple Vaginitis Simple Vaginitis
Inflammation of the lower genital tractInflammation of the lower genital tractResult of one or more of the following:Result of one or more of the following:
MenopauseMenopause Trichomonas vaginalisTrichomonas vaginalis Candida albicansCandida albicans Changes in normal floraChanges in normal flora Alkaline pHAlkaline pH Foreign bodiesForeign bodies Chemical irritantsChemical irritants DiabetesDiabetes
Management of Vaginitis Management of Vaginitis
Perineal cleaning after urination or Perineal cleaning after urination or defecationdefecation
Wearing cotton underwearWearing cotton underwearAvoiding strong douches and feminine Avoiding strong douches and feminine
hygiene sprayshygiene spraysAvoiding tight-fitting pantsAvoiding tight-fitting pantsUsing estrogen creamsUsing estrogen creamsEating yogurt with antibioticsEating yogurt with antibiotics
Vulvitis Vulvitis
Inflammatory condition of the vulva Inflammatory condition of the vulva (itching) associated with symptoms of (itching) associated with symptoms of pruritus and a burning sensationpruritus and a burning sensation
Other causes include the following:Other causes include the following:Atrophic vaginitisAtrophic vaginitisVulvar kraurosisVulvar kraurosisVulvar leukoplakiaVulvar leukoplakiaCancerCancerUrinary incontinenceUrinary incontinence
Management of VulvitisManagement of Vulvitis
Measures to relieve itching, including Measures to relieve itching, including sitz bathssitz baths
Prescribed antibioticsPrescribed antibioticsTreatment of pediculosis and scabies, if Treatment of pediculosis and scabies, if
neededneededLaser therapyLaser therapy
Toxic Shock Syndrome (TSS)Toxic Shock Syndrome (TSS)
First recognized in 1980 when it was First recognized in 1980 when it was found to be related to menstruation and found to be related to menstruation and tampon usetampon use
Staphylococcus aureus Staphylococcus aureus Abrupt onset of high temperature, Abrupt onset of high temperature,
headache, sore throat, vomiting, headache, sore throat, vomiting, diarrhea, generalized rash, hypotensiondiarrhea, generalized rash, hypotension
Penicillin or vancomycinPenicillin or vancomycin
Follicular CystsFollicular Cysts
Cyst—usually small and may be Cyst—usually small and may be asymptomatic unless it rupturesasymptomatic unless it ruptures
Rupture of a follicular cyst or torsion—Rupture of a follicular cyst or torsion—may cause acute, severe pelvic painmay cause acute, severe pelvic pain
Medical managementMedical managementSurgical management includes:Surgical management includes:
CystectomyCystectomyOophorectomyOophorectomy
Corpus Luteum CystCorpus Luteum Cyst
Occurs after ovulation and often with Occurs after ovulation and often with increased secretion of progesterone; increased secretion of progesterone; usually small, purplish redusually small, purplish red
May cause unilateral low abdominal or May cause unilateral low abdominal or pelvic pain that is dull or achingpelvic pain that is dull or aching
Intraperitoneal hemorrhage possible if Intraperitoneal hemorrhage possible if cyst rupturescyst ruptures
Theca-Luatein CystsTheca-Luatein Cysts
These cysts are uncommon, often These cysts are uncommon, often associated with hydatidiform molar associated with hydatidiform molar pregnancy.pregnancy.
Cysts develop as a result of prolonged Cysts develop as a result of prolonged stimulation of the ovaries by excessive stimulation of the ovaries by excessive amounts of hCG.amounts of hCG.
Cysts regress spontaneously within 3 Cysts regress spontaneously within 3 months with the removal of the molar months with the removal of the molar pregnancy.pregnancy.
Polycystic OvaryPolycystic Ovary
High levels of luteinizing hormone High levels of luteinizing hormone overstimulate the ovaries, producing overstimulate the ovaries, producing multiple cysts on one or both ovaries.multiple cysts on one or both ovaries.
Endometrial hyperplasia or even Endometrial hyperplasia or even carcinoma may result.carcinoma may result.
Typical client is obese, hirsute, has Typical client is obese, hirsute, has irregular menses, and may be infertile.irregular menses, and may be infertile.
Treatment is with oral contraceptives, Treatment is with oral contraceptives, surgery, or clomiphene.surgery, or clomiphene.