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.

Other Benign Other Benign Ovarian Cysts and TumorsOvarian Cysts and Tumors

Dermoid cystsDermoid cystsOvarian fibromasOvarian fibromasEpithelial ovarian tumorsEpithelial ovarian tumorsUterine leiomyomasUterine leiomyomas