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Published by: Prince Eric on Feb 24, 2011
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Anatomy Recall

Common Gynecological Complaints          Vaginal discharge Vaginal/ Vulvar pruritus Genital ulceration Inguinal lymphadenopathy Pelvic mass Dyspareunia Pelvic pain Vaginal bleeding Amenorrhea .


Gynecological Infections Lower genital tract  Vulvitis  Vaginitis  cervicitis Upper genital tract  Endometritis  Pelvic inflammatory disease (PID) Sexually Transmitted Diseases/ Infections (STD/ STI)  Bacterial  Viral  Others .

TSH.Ultasound .endometrial Vaginal/ endocervical culture VDRL Papanicolau Smear Colposcopy Laparoscopy       .vulvar . FSH.HCG .LH.Diagnostic Tests  Bloodwork .Hysterosalpingography . PRL Imaging .Sonohystography  Genital tract biopsy .CBC .vaginal .

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) .

non-absorbent underclothing Poor hygiene Coital lubricant Latex in diaphragm or condom .Causes ( irritation)         Frequent douching Deodorant spray Laundry soap and fabric softener Bath water additives Tight non-porous.

milky white discharge that clings to the walls of the vagina Trichomonas ± painful urination. cheesy discharge Bacterial vaginosis ± The fishy smell is stronger after sexual intercourse . sometimes frothy. vaginal discharge. painful sexual intercourse. and a yellow-green to gray.VULVOVAGINITIS  Manifestation  Vaginal discharge    Candida ± thick. thin.    Vulvar irritation Pruritus Burning pain . foul smelling.

consistency. presence of odor. Vaginal culture Pap smear .Management       Complete physical examination & history Note the discharge ( color. duration and symptoms ) Vulva is examined for redness. edema and excoriation and abnormal lesion sample of the vaginal discharge for tests and microscopic analysis.

 Treatment    Specific causes of discharge require specific therapy Candida ± miconazole 2% or clotrimazole 1% cream. . Sexual partner also treated.o x 5days or 250 mg tid. vaginal tablet or suppositories x3-7days Trichomonas ± metronidazole 500mg BID p.

 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. .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.

Use condoms to avoid sexually transmitted disease.Nursing care     Thoroughly dry oneself after bathing and remove a wet bathing suit promptly. cervical caps. wipe from front to back to avoid spreading intestinal bacteria to the vagina. Clean diaphragms. . and spermicide applicators after use. After a bowel movement. Avoid wearing tight clothing and wear cotton underwear.

and E. . fruits. are recommended. as well as B complex vitamins. soy sauce. Foods to avoid include cheese. including A. thus helping to prevent some forms of vulvovaginitis. and vitamin D. C. Wearing cotton underwear and loose fitting clothes and avoiding panty hose can help keep the vagina cool and dry. chocolate. sugar. and any fermented foods.   Antioxidant vitamins. alcohol.


vaginosis .not associated with WBC .VAGINITIS  inflammation of the vagina characterized by an increased vaginal discharge containing numerous WBCs Causes:  Douches  Antibiotics  Hormones  Contraceptives (oral and topical)  Change in sexual partners  In contrast.

Signs and Symptoms:  Itching  Burning  Pain  Erythema  Edema .

gardnerella) most common cause of abnormal vaginal discharge most common vaginal infection in childbearing women not considered a sexually transmitted disease normally dominant organism lactobacillus is replaced with a high concentration of facultative aerobic and anaerobic bacteria . hemophilus vaginitis.BACTERIAL VAGINOSIS      nonspecific vaginitis.

5  Positive whiff test (fishy odor will be released when KOH is added to vaginal secretion on a slide or on the lip of the withdrawn speculum  clue cells on wet mount (vaginal epithelial cells coated with bacteria that obscure cell borders) .Signs and Symptoms:  Fishy odor  Increased thin vaginal discharge (no inflammatory response) Diagnosis (based on Amsel criteria)  White/gray thin adherent discharge  Ph > 4.

075%) or Clindamycin cream (2%) BID for 7 days  Sexual partner does not need treatment .Treatment:  Oral agents: Metronidazole 500 mg or Clindamycin 300 mg BID for 7 days  Vaginal agents: Metronidazole gel (.

Nursing interventions  Teach the importance of completing the course of medication and of not consuming alcohol while taking Metronidazole and 48 hours after completing the treatment  Remind client to avoid intercourse  Instruct good hygiene .

CANDIDA VAGINITIS  vulvovaginitis candidiasis/ yeast vaginitis/ yeast or fungus/ Moniliasis second most common cause of abnormal vaginal discharge common cause: Candida albicans   .

Predisposing factors  Repeated courses of systemic or topical antibiotics  Diabetes especially when uncontrolled  Pregnancy  Obesity  Use of corticosteroids and exogenous hormones  Local allergic or hypersensitivity reaction .

white discharge that has no odor  Vaginal erythema. curd-like/ cheeselike.Signs and Symptoms  Thick. edema and tenderness  Itchiness of the vulva  Dryness  Painful urination especially when urine flows in the vulva  Dyspareunia .

5 suspect trichomoniasis or bacterial vaginosis)  KOH wet smear.pseudohyphae Treament  Oral agent: Fluconazole 150 mg (single dose)  Vaginal agents: antifungal preparation (fungicidal azole creams: Clotrimazole.Diagnosis  Vaginal pH is normal (if > 4. 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 .

live culture yogurt . Nystatin)  Inform the patient that the disease can be transmitted to the newborn leading to the development of ORAL THRUSH .increase vaginal acidity  Local application of anti fungal agents (eg. scented pads (allergies and irritation)  Vitamin C.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.

Home Remedies:  Vaginal douche of two teaspoons ordinary baking powder dissolved in one quart of warm water  Application of gentian violet to the vagina & perineum. Use sanitary pad to prevent staining of undergarments. .

BARTHOLIN¶S CYST  occlusion of a duct with mucus retention resulting in a nontender mass approx. caused by cancer  Unknown (many cases) . 1-4cm in size Causes  if the duct becomes blocked for any reason: infection. injury or chronic inflammation  Very rarely.

thromatis) Symptoms:  Bartholin¶s Cyst (asymptomatic)  Bartholin¶s Abscess .pain or tenderness. E. dyspareunia Diagnosis  clinical Management  incision and drainage  marsupialization ± entire abscess is incised and sewn open  Word catheter for 2 ± 4 weeks  broad spectrum antibiotic . fecalis.BARTHOLIN¶S CYST Causative organisms: Staphylococcus aureus (others: S. gonorrhea. coli. N. C.

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 .

Infection of the fallopian tubes .SALPHINGITIS    Acute salpingitis is a gynecologic condition consisting of infection and inflammation of the oviducts. the terms acute salpingitis and pelvic inflammatory disease (PID) are used synonymously to describe acute infection of the female upper genital tract.

SALPHINGITIS  AT RISK      Occur predominantly in women under 35 yrs old Sexually active Child birth ( peurperal fever) Abortion IUDs .

Gardnerella vaginalis. Mycoplasma genitalium.SALPHINGITIS  CAUSES:    Chlamydia trachomatis 15-75 % Neisseria gonorrhea Other associated organisms include Ureaplasma urealyticum. and mixed anaerobic and aerobic bacteria . Trichomonas vaginalis.

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 Wbc elevated     CBC  Culture & smear for Gram stain Culdocentesis ± examination of fluid Laparoscopy .

Women should remain abstinent from sexual activity until they are cured of symptoms and they have completed their full regimen of antibiotics  Patient education  .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     Primary prevention involves avoiding either exposure to STDs or acquisition of infection following exposure. 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. Counsel patients regarding safe sex practices in a manner appropriate to both the patient's understanding of sexual issues and stage of development.


SEXUALLY TRANSMITTED DISEASES/INFECTION ( STD/STI)       Trichomoniasis Chlamydia Gonorrhea Syphilis Herpes simplex Condylomata acuminatum .

TRICHOMONIASIS  protozoan infection: Trichomonas vaginalis Signs and Symptoms  Frothy yellow-green malodorous vaginal discharge  ³strawberry´ cervix  Vaginal irritation & inflammation  Dyspareunia  Dysuria  Vulvar itching Among males: usually asymptomatic .




5+ (alkaline) Management  Sexual partner should receive oral treatment.  Metronidazole (Flagyl) 500 mg BID for 7 days or a single 2 g dose (contraindicated during pregnancy) .TRICHOMONIASIS Diagnosis  microscopic exam of vaginal discharge -positive motile flagellated protozoa in a saline wet mount  elevated vaginal pH 5.

premature rupture of membranes and postcesarean infection .  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.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 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 interventions  Include sexual partner in treatment.

CHLAMYDIA most common cause of mucopurulent cervicitis most common bacterial STD in women caused by gram (-) bacterium Chlamydia trachomatis Vertical transmission to newborns may result in conjunctivitis and otitis media Tends to coincide with gonorrheal infection      IP: 2-10 days 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 .

low birth weight and perinatal mortality due to placental transmission) .  may cause conjunctivitis (also associated with premature rupture of membranes. preterm labor and endometriosis.Complications  Pelvic inflammatory disease (PID)  Ectopic pregnancy  Fetus transmittal (vaginal birth).


may have purulent vaginal discharge.GONORRHEA   Morning drop. urethritis (decreased sperm count)  Newborn: yellow discharge. both eyes . which causes inflammation of the mucus membrane of the genito urinary tract IP: 3-7 days Signs and Symptoms  Females: may be asymptomatic. dyspareunia Males: Painful urination. pelvic pain and fever. purulent yellow penile discharge. Clap Sexually transmitted disease caused by gram (-) Neisseria gonorrhea.

Diagnosis  gram stain and culture of cervical secretions on Thayer Martin medium 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) .



 Return to clinic for check-up in 4 to 7 days after completion of treatment.Nursing interventions Health Teachings:  Avoid sexual intercourse until cured of the infection or use condom to prevent transmitting the infection.  Monitor treatment .  Examination and treatment of sexual partner to prevent reinfection is necessary.

stillbirth and congenital anomalies 3rd trimester infection causes enlarged liver. and 6-14% fetal infection in latent syphilis 2nd trimester infections cause spontaneous abortion. skin rash and jaundice in a newborn . spleen.SYPHILIS    caused by motile anaerobic spirochete Treponema pallidum ³ beautiful´ fast moving but delicate spiral thread can cross the placental barrier IP: 10-90 DAYS  ‡ ‡ can cause 100% fetal infection if primary and secondary infection is untreated. preterm labor.

anus or mouth. neurosyphilis/permanent damage (insanity).painless chancre on genitalia.painless condylomata lata on vulva .hepato/ splenomegaly . anorexia.headache. gumma (necrotic granulomatous lesions).Signs and Symptoms  Primary Stage . fever Latent syphilis ± asymptomatic Tertiary Stage ±most destructive stage. aortic aneurysm    .about 2 months after primary syphilis resolves. generalized maculopapular skin rash including palms and soles . most infectious stage Secondary Stage .

gumma .Primary ± painless chancre Secondary ± generalized rash Tertiary .














1st and 2nd stage .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.Diagnosis  VDRL (venereal disease research laboratory test) or RPR (rapid plasmin reagin) ± nonspecific tests .

Alternatives: Tetracycline 500 mg orally QID or Doxycycline 100 mg orally BID Tertiary .IV Pen G Erythromycin & Cefriaxone are the drugs of choice for pregnant women   Complications  Congenital syphilis in newborn if untreated in late pregnancy  Late abortion  Stillbirth .4 M U IM) .Pen G (Benzathine Penicillin G 2.Management  Primary and secondary and early latent disease .

 Use condom during intercourse.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.

Emphasize the importance of screening for syphilis during the first prenatal visit for early detection & treatment. nausea. a reaction to penicillin characterized by: fever. No sexual intercourse until lesions disappear After completion of treatment. 6 mos & 12 mos.  Sexual partners must also be treated to prevent reinfection. This is a normal reaction that subsides within 24 hours. & tachycardia. the woman is treated monthly & the sexual partner at 3 months. headache. chills. Inform patients treated with penicillin about Jarish Herxheimer reaction. malaise.   . Fetus will not be affected if the mother is treated before the 5th month.

fever.20 days after exposure  Painful genital ulcer  Recurrent episodes 1-6x a year (during stress. glans penis) 2 . perineum. fever)  Vulvar burning and pruritus  Painful vesicles (cervix. menstruation)  Dyspareunia Diagnosis  Viral culture  Pap smear (shows cellular changes)  Tzanck smear (scraping of ulcer for staining) ± multinucleated giant cells . nausea.HERPES GENITALIS  Sexually transmitted disease caused by the Herpes Simplex Virus 2 (HSV 2) Signs and Symptoms  Flulike symptoms (malaise. vagina. myalgia.

Management  Antiviral agents ± Acyclovir 200 mg PO q 4 hrs for 5 days  Sitz bath  Analgesics .



Complications:  Meningitis  Neonatal infection (vaginal birth)  Trigeminal herpes zoster (facial muscle paralysis) Health teachings ‡ NO sexual activity in the presence of lesions and 10-14 days after lesions subsided ‡ Keep vulva clean and dry in the presence of lesions (wearing of cotton underwear) ‡ Sitz bath ‡ use foley catheter if retention persists ‡ Povidone.iodine douche and acyclovir NOT used during pregnancy .

18 and 31 ± cervical cancer Signs and Symptoms: Single or multiple dry soft. urethra. penis  Can evolve into larger cauliflower-like growths  Vaginal bleeding. or anal area. odor and dyspareunia . discharge.CONDYLOMA ACUMINATUM      Genital warts Genital or venereal warts caused by Human Papilloma Virus (HPV) May be a precursor to cervical cancer HPV types 6 & 11 ± condyloma acuminatum HPV types 16. vagina. cervix. fleshy painless (wartlike) growths on the vulva.

Diagnosis  Clinical  Pap smear-shows cellular changes (koilocytosis) Acetic acid swabbing (will whiten lesion) Management  Small lesions ± treated topically with podophyllin or trichloroacetic acid  Larger lesions ± ablated with cryotherapy. laser vaporization or surgical excision.  Recurrence rate : 20% Complications ‡Neoplasia ‡Neonatal laryngeal 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 .

streptococci .Pelvic Inflammatory Disease   Caused by microorganisms colonizing endocervix ascending to endometrium and fallopian tubes Due to sexually transmitted microorganisms ie Neisseria. Haemophilus influenza. Chlamydia.

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 .


History and PE CBC Vaginal and endocervical culture VDRL Endometrial biopsy - endometritis Sonography ± tubo-ovarian abscess Laparoscopy - salpingitis


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

Manifestations: fever, rash on trunk, desquammation of skin, hypotension, dizziness, vomiting, diarrhea, myalgia, inflamed mucous membranes

Diagnostics: Elev BUN, Crea Elev AST, ALT, total bilirubin Dec platelets 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


PREMENSTRUAL SYNDROME (PMS)  it has such a wide variety of signs and symptoms. fatigue. irritability and depression are among the most common symptoms of PMS. tender breasts. bloatedness. Occurs during the 7-10 days before menstruation and disappear few hours after the onset of menstrual flow .   Mood swings. food cravings.

PREMENSTRUAL SYNDROME (PMS) CAUSES Unknown Fluctuation in estrogen and progesteron .

decreasing sugar + vitamin B complex counseling .PMS Treatment Symptomatic relief Tranquilizer as prescribed Dietary changes : increasing protein.

 NSAIDs such as ibuprofen (Advil. Oral contraceptives.Treatments and drugs   Antidepressants. used to temporarily stop ovulation. Taken before or at the onset of the period. Medroxyprogesterone acetate (Depo-Provera). taking diuretics. can help your body shed excess water through your kidneys. stop ovulation and stabilize hormonal swings. Motrin. swelling and bloating of PMS. . Nonsteroidal anti-inflammatory drugs (NSAIDs). others) or naproxen sodium (Aleve) can ease cramping and breast discomfort. or water pills.    Diuretics.

. Avoid caffeine and alcohol. exercise and approach daily life. Limit salt and salty foods to reduce bloating and fluid retention. you may need a daily calcium supplement. more frequent meals each day to reduce bloating and the sensation of fullness.Nursing care  Patient education   making changes in the way you eat. vegetables and whole grains. such as fruits. Choose foods rich in calcium. Try these approaches: Modify your diet       Eat smaller. Take a daily multivitamin supplement. If you can't tolerate dairy products or aren't getting adequate calcium in your diet. Choose foods high in complex carbohydrates.

anxiety or trouble sleeping (insomnia). Practice progressive muscle relaxation or deepbreathing exercises to help reduce headaches. yoga or massage as ways to relax and relieve stress.Nursing care  Reduce stress    Get plenty of sleep. .


.Dysmenorrhea   Is a menstrual condition characterized by severe and frequent menstrual cramps and pain associated with menstruation. Dysmenorrhea may be classified as primary or secondary.

due to some physical cause and usually of later onset. .e. painful menstrual periods caused by another medical condition present in the body (i. endometriosis).  Primary dysmenorrhea (Functional)..cyclic pain associated with menses during ovulatory cycles but without demonstrable lesions affecting the reproductive structure Secondary dysmenorrhea ( Acquired) . pelvic inflammatory disease.

primary dysmenorrhea experience abnormal uterine contractions as a result of a chemical imbalance in the body (particularly prostaglandin and arachidonic acid . .both chemicals which control the contractions of the uterus).What causes dysmenorrhea?   The cause of dysmenorrhea depends on whether the condition is primary or secondary.

What causes dysmenorrhea?  Secondary dysmenorrhea      most often endometriosis pelvic inflammatory disease (PID) uterine fibroids abnormal pregnancy (i. or polyps in the pelvic cavity .e. ectopic) infection. tumors. miscarriage..

Who is at risk for dysmenorrhea?   any female can develop dysmenorrhea increased risk for the condition:     females who smoke females who drink alcohol during menses (alcohol tends to prolong menstrual pain) females who are overweight females who started menstruating before the age of 11 .

symptoms of dysmenorrhea Each adolescent may experience symptoms differently.             cramping in the lower abdomen pain in the lower abdomen low back pain pain radiating down the legs nausea vomiting diarrhea fatigue weakness fainting headaches Start before or with menses and Peak 24Hrs and subsides after 2 days .

) ± magnetic resonance imaging (MRI) ± laparoscopy . ultrasound (Also called sonography.Diagnosis       Medical history and a complete physical examination Pelvic examination. . is inserted into an incision in the abdominal wall. hysteroscopy .a minor surgical procedure in which a laparoscope. Using the laparoscope to see into the pelvic and abdomen area.a visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina. a thin tube with a lens and a light.

. or NSAIDs. nonsteroidal antiinflammatory medications. such as aspirin.e. ibuprofen) .to reduce pain ± given 24-48H before mense & continued through 1-2 days of the cycle acetaminophen .Nursing care   Patient education Primary dysmenorrhea    Assurance that her reproductive organ are normal will give a physiologic support prostaglandin inhibitors (i.

        oral contraceptives (ovulation inhibitors) progesterone (hormone treatment) dietary modifications (to increase protein and decrease sugar and caffeine intake) vitamin supplements regular exercise heating pad across the abdomen hot bath or shower abdominal massage .

 Secondary dysmenorrhea   Relieved symptomatically or by correction of underlying abnormality Counseling regarding symptoms may increase understanding and lead to activities for stress management. .

The cells attach to other organs. are found outside the uterus.  when cells from the uterus.     Pelvis most common location Bleeding results to inflammation. called endometrial cells. scarring of peritoneum and adhesions Cause unknown Common in 20-45 yrs old .Endometriosis  Endometrial tissue outside the uterine cavity.

Endometriosis .

Common Sites 0f Endometriosis Formation .


Risk Factors:     Retrograde menstrual flow of endometrium Physiologic disruption after gyne surgery or cesarean birth Hereditary Possible immunologic effect .

r/t menstruation Dyspareunia Abnormal uterine bleeding Fixed tender retroverted uterus Palpable nodules in the cul de sac Diagnostics: laparoscopy   .Manifestations:      Pelvic pain ± dull/cramping.

low estrogen and high androgens to suppress ovulation.Management:       OCP-combination contraceptives to induce amenorrhea Analgesics NSAIDS Danazol ± antiprogesterone. promote amenorrhea and decrease endometrial support GnRH agonists ie leuprolide suppress the menstrual cycle through estrogen antagonism Progestins ie Medroxyprogesterone ± antiendometrial effect . suppresses GnRH.

but then stopped having periods.AMENORRHEA   Amenorrhea ² the absence of menstruation ² can happen during puberty or later in life. Secondary amenorrhea occurs when you were previously menstruating.  Pregnancy ± most common . 2 types   Primary amenorrhea describes a condition in which you haven't had any menstrual periods by age 16.

Depending on the cause of amenorrhea. . Secondary amenorrhea. You have no periods for three to six months or longer.     milky nipple discharge headache vision changes excessive hair growth on your face and torso (hirsutism). You have no menstrual period by age 16.Symptoms     No menstrual period Primary amenorrhea.

. and physical or psychological stress can all contribute to a disruption in the normal function of the hypothalamus. a tumor may prevent your hypothalamus from functioning normally. such as anorexia. Affects less than 1 percent of adolescent girls The most common causes of primary amenorrhea include: Chromosomal abnormalities.    Functional hypothalamic amenorrhea is a disorder of the hypothalamus ² an area at the base of the brain that acts as a control center for the body and regulates the menstrual cycle. 2. eating disorders. Problems with the hypothalamus. Less commonly. Excessive exercise.Causes Primary amenorrhea   1.

Sometimes problems arise during fetal development that lead to a baby girl being born without some major part of her reproductive system. 4. A tumor or other invasive growth may disrupt the pituitary gland's ability to perform this function. cervix or vagina.Pituitary disease. The pituitary is another gland in the brain that's involved in regulating the menstrual cycle. An obstruction of the vagina may prevent visible menstrual bleeding.Causes Primary amenorrhea 3. Because her reproductive system didn't develop normally. . such as her uterus. she won't have menstrual cycles.Lack of reproductive organs. 5. A membrane or wall may be present in the vagina that blocks the outflow of blood from the uterus and cervix.Structural abnormality of the vagina.

Some women who take birth control pills may not have periods. When oral contraceptives are stopped. Contraceptives.Causes : Secondary amenorrhea   Secondary amenorrhea is much more common than primary amenorrhea. . it may take three to six months to resume regular ovulation and menstruation. Many possible causes of secondary amenorrhea exist:   Pregnancy-most common cause of amenorrhea.

. Regular menstrual periods usually resume after your stress decreases. Mothers who breast-feed often experience amenorrhea. Pregnancy can result despite the lack of menstruation. Although ovulation may occur.Causes : Secondary amenorrhea .   Breast-feeding. Mental stress can temporarily alter the functioning of your hypothalamus ²Ovulation and menstruation may stop as a result. Stress. menstruation may not.

 Medication.Causes : Secondary amenorrhea . a male hormone. This results in a decrease in the pituitary hormones that lead to ovulation and menstruation. menstruation typically resumes. Hormonal imbalance. Chronic illness may postpone menstrual periods. A common cause of amenorrhea or irregular periods is polycystic ovary syndrome (PCOS).     This condition causes relatively high and sustained levels of estrogen and androgen. some chemotherapy drugs and oral corticosteroids Illness. acne and sometimes excess facial hair. antipsychotics. rather than the fluctuating levels seen in the normal menstrual cycle. PCOS is associated with obesity. . antidepressants. amenorrhea or abnormal heavy uterine bleeding. As you recover.

Women who have an eating disorder.Causes : Secondary amenorrhea  Low body weight. long-distance running or gymnastics. hypothyroidism commonly causes menstrual irregularities. Excessive exercise. Thyroid disorders can also cause an increase or decrease in the production of prolactin ² a reproductive hormone generated by the pituitary gland. stress and high energy expenditure.    .    interrupts many hormonal functions in your body. Several factors combine to contribute to the loss of periods in athletes. such as ballet. An altered prolactin level can affect the hypothalamus and disrupt the menstrual cycle. including amenorrhea. such as anorexia or bulimia. may find their menstrual cycle interrupted. including low body fat.  Thyroid malfunction. potentially halting ovulation. Women who participate in sports that require rigorous training.

Asherman's syndrome. Excess prolactin can interfere with the regulation of menstruation.     . but it sometimes requires surgery. such as a dilation and curettage (D and C) Caesarean section or treatment for uterine fibroids.Causes : Secondary amenorrhea  Pituitary tumor. which can result in very light menstrual bleeding or no periods at all. Uterine scarring prevents the normal buildup and shedding of the uterine lining. This type of tumor is treatable with medication.  A noncancerous (benign) tumor in the pituitary gland (adenoma or prolactinoma) can cause an overproduction of prolactin. occur after uterine procedures.  Uterine scarring. a condition in which scar tissue builds up in the lining of the uterus.

  The lack of ovarian function associated with menopause decreases the amount of circulating estrogen in the body. .   Menopause usually occurs between ages 45 and 55.Causes : Secondary amenorrhea  Premature menopause. Premature menopause may result from genetic factors or autoimmune disease. which in turn thins the uterine lining (endometrium) and brings an end to the menstrual periods. but often no cause can be found. premature. If menopause before age 40.

consult :   never had a menstrual period. but have missed three or more periods in a row .Nursing care  Patient education  For primary or secondary amenorrhea. and you're age 16 or older previously menstruated.

. perform a pelvic exam In young women. History and physical assessment pregnancy test. check for signs and symptoms of changes that are normal to puberty.Tests and diagnosis       Not life threatening Finding the underlying cause and may require more than one kind of testing.

laparoscopy or hysteroscopy ² minimally invasive surgical techniques to view the internal organs ² may sometimes be recommended. thyroid function test or evaluation of prolactin level. A progestin challenge test ² in which they take a hormonal medication (progesteron) for seven to 10 days to trigger bleeding computerized tomography magnetic resonance imaging ultrasound.  Imaging tests     . can reveal pituitary tumors or structural abnormalities in your reproductive organs.Tests and diagnosis  Blood tests    hormone levels.

If with PCOS or athletic amenorrhea. physical activity or stress level.    suggest that they make changes to their lifestyle depending on their weight. . Amenorrhea caused by thyroid or pituitary disorders may be treated with medications. may prescribe oral contraceptives to treat the problem.Nursing care  if any ² depends on what's causing the amenorrhea.

.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.

pregnancy related disorders. AUB. or timing  DUB.most common type of AUB and is frequently defined as irregular uterine bleeding unrelated to organic pathology. medication. . duration.diagnosis referring to any uterine bleeding that is irregular in amount. systemic condition.

spontaneos abortion 2.medicationamphetamines.INH. pregnancy-ectopic.. causes of AUB: 1.thyroid dysfunction.anticoagulants.steroids.ITP .diabetes 3.cushing syndrome.leukemia. systemic dse. SSRIs 4.endocrine problem.

are regular and tend to be cyclic. or abnormal amount of bleeding 2.due to lack of progesterone in the luteal phase of anovulatory cycles leads to unstable . often lead to abnormal cycle interval.although the bleeding pattern are often abnormal. Types:   1. ovulatory DUB.anovulatory DUB.menorrhagia is commonly observed and is commonly associated with pelvic pathology .excessively vascular endometrium.

 Causes of anovulation:  Physiologic:     Pregnancy Lactation Perimenarche Perimenopause Hyperandrogenic disorder Hyperprolactinemia Extreme stress  Pathologic causes:    .

pelvic examination 2.  s/sx: uterine bleeding Physical Examination:    1. bimanual examination .Speculum examination 3.

D and C. normalize the bleeding 2. Hysterectomy . correct any anemia 3. medication ± oral contraceptives 2. Management:Goal:1.prevent cancer 1. surgery. restore quality of life 4.

Prolonged (>7 d) or excessive (>80 mL daily) uterine bleeding occurring at regular intervals Metrorrhagia .Uterine bleeding occurring at irregular and more frequent than normal intervals   . Dysfunctional bleeding from the uterus can be described as follows: Menorrhagia .

Uterine bleeding occurring at regular intervals of less than 21 days Oligomenorrhea .Prolonged or excessive uterine bleeding occurring at irregular and more frequent than normal intervals Intermenstrual bleeding (spotting) .Uterine bleeding of variable amounts occurring between regular menstrual periods Polymenorrhea .Uterine bleeding occurring at intervals of 35 days to 6 months Amenorrhea .No uterine bleeding for 6 months or longer .     Menometrorrhagia .

It may be the treatment of choice when bleeding is severe. Hysteroscopy can be used in place of D&C and allows direct visualization of the endometrial cavity with directed biopsy.   . and it allows more extensive sampling of the uterine cavity and also has a higher sensitivity than endometrial biopsy. D & C. Transvaginal ultrasonography (TVUS): if the patient may be pregnant or may have anatomic problems or polycystic ovarian syndrome.Management   pelvic ultrasonography.can be both therapeutic and diagnostic.

 perform an endometrial sampling or endometrial biopsy to diagnose intrauterine pathology and to exclude endometrial malignancy. All patients older than 35 years Obese patients Patients with diabetes mellitus Patients with hypertension Patients with suspected polycystic ovarian disease  Perform endometrial biopsy for the following patients:       .  Pelvic examination Before instituting therapy.

uncontrolled bleeding. Consider D&C rather than endometrial biopsy if suspected diagnosis is endometritis. Perform if histologic examination is required but biopsy is contraindicated. or carcinoma. . D&C is indicated in the following situations:      Consider D&C in patients at high risk for endometrial hyperplasia and carcinoma. Perform in patients having heavy. atypical hyperplasia. Perform if medical curettage fails.

bleeding stop in 12Hrs Progestin must be started at the same time  For acute profuse DUB    Oral contraceptive for 3 months to prevent recurrence . Medical management  Estrogen therapy  Conjugated estrogen ( 10 mg/day) controls most acute bleeding in 24hrs   Progestin Therapy ( Provera) Both hormones is continued 7-10 days Parenteral estrogen.

Nursing care         Physical assessment & history Monitor vital sign Monitor bleeding Monitor I & O Administer IVF as prescribed Nursing priority : Bleeding Informed consent for the procedure Emotional support .

Disturbance in sexuality to women Dyspareunia Vaginismus .

Painful sexual intercourse.What is Dyspareunia?   Vaginal pain after sexual intercourse. .

2.TYPES Dyspareunia 1. Superficial dyspareunia: Pain or dysfunction felt upon initial penetration Deep dyspareunia: Pain or dysfunction felt deep within the pelvis during intercourse .

CAUSES Dyspareunia         Poor vaginal lubrication Reduced libido Reduced estrogen Vaginal dryness Inadequate foreplay Menopause Perimenopause Lactation .causes vaginal dryness .

if performed for childbirth Vaginal infection Cystitis Urethritis Vaginal infection Vulva infection Atrophic vaginitis Vaginal changes from childbirth .Dyspareunia         Post-childbirth  Episiotomy .

CAUSES Dyspareunia      Narrow vaginal  Hymen Anxiety Psychological disorders  Vaginismus Endometriosis Hemorrhoids .

CAUSES Dyspareunia   Pelvic infection  Pelvic inflammatory disease Vaginal tumors Vaginal surgery Genital tract tumor      Pelvic disorders Sexual organ disorders Some causes of deep penetration intercourse pain in women include:    Pelvic inflammatory disease Pelvic tumor Irritable bowel syndrome .

upon entry. stabbing ±Include complete psychiatric history and exam . with exams only. prior occurrence(s) ±Associations: Symptoms may occur with all vaginal or vulvar contact. with intercourse only.MANAGEMENT Dyspareunia  History and physical examination with pelvic and rectal exams ±Timing: Onset (e. after intercourse). aching.. throbbing. sharp. with masturbation. persistence after intercourse. or with memories or recollections of prior occurrences or traumatic experiences ±Alleviating and aggregating factors during intercourse ±Qualifiers: Burning. duration.g. dull.

If pregnancy is suspected.Dyspareunia     Routine studies include a CBC. sedimentation rate. If there is a pelvic mass. . urinalysis. and vaginal smear and culture. urine culture and sensitivity. a pregnancy test should be done. pelvic ultrasound may be helpful. A Pap smear should also be done.

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.

2.CAUSES 1. 3. Fear of sex Unpleasant sexual experience Negative attitude to sex .


.Prognosis of Vaginismus Most women recover to normal sex life and motherhood with treatment.

SEXUAL DYSFUNCTION IN MALE Erectile dysfunction impotence .

long enough for vaginal penetration or partner satisfaction.Erectile dysfunction ( impotence)   Inability of the man to produce or maintain erection . 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. 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 . antihistamines and medications to treat high blood pressure.


 Psychological causes of erectile dysfunction      Depression Anxiety Stress Fatigue Poor communication or conflict with your partner .

beginning with feelings of sexual excitement. A number of things can interfere with sexual feelings and lead to ² or worsen ² erectile dysfunction. These can include:      Depression Anxiety Stress Fatigue Poor communication or conflict with your partner . Psychological causes of erectile dysfunction The brain plays a key role in triggering the series of physical events that cause an erection.

 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. Tests of this type confirm that there is not a physical abnormality causing erectile dysfunction.  Nocturnal tumescence test. This test can check blood flow to your penis. It's generally done with local anesthesia by a urologist who specializes in erectile dysfunction. Neurological evaluation.  . 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.   Ultrasound. Dynamic infusion cavernosometry and cavernosography (DICC). and that the cause is likely psychological. your penis was erect at some time during the night. If the tape is separated in the morning.

 ACTION :  . This increases the amount of blood flow and allows a natural sequence to occur ² an erection in response to sexual stimulation. these drugs enhance the effects of nitric oxide. Oral medications Oral medications available to treat ED include:    Sildenafil (Viagra) Tadalafil (Cialis) Vardenafil (Levitra) Chemically known as phosphodiesterase inhibitors. a chemical that relaxes muscles in the penis.

Penis pumps   This treatment involves the use of a hollow tube with a hand-powered or battery-powered pump.  Hormone replacement therapy For the small number of men who have testosterone deficiency. remove the tension ring after intercourse. pump is used to suck out the air.  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 erection typically lasts long enough for a couple to have sex. But the long-term success of this surgery is unclear. then remove the vacuum device. slip a tension ring around the base of the penis to maintain the erection. The tube is placed over the penis. This creates a vacuum that pulls blood into the penis.  The goal of this treatment is to correct a blockage of blood flow to the penis so that erections can occur naturally. Once you achieve an adequate erection. testosterone replacement therapy may be an option.

 Penile pump Penis pump .

This treatment is often expensive and is usually not recommended until other methods have been considered or tried first. there is a small risk of complications such as infection. especially when your partner participates. Psychological counseling and sex therapy   Stress. These implants consist of either an inflatable device or semirigid rods made from silicone or polyurethane.  Penile implants The inflatable device allows to control when and how long you have an erection. . anxiety or depression is the cause of erectile dysfunction Counseling can help. As with any surgery.

Penile implant

Nursing care 

Patient education 

Limit or avoid the use of alcohol. Avoid illegal drugs such as marijuana. Stop smoking. Exercise regularly. Reduce stress. Get enough sleep. Get help for anxiety or depression. advised regular checkups and medical screening tests. 

Communicate with patient and partner openly

Imperforate hymen Congenital absence of vagina Septate vagina Uterine malformation

Imperforate hymen: 

Lack of opening in the vaginal hymen occurring in 0.1% of infant girls. No menstrual bleeding Enlarged uterus


Amenorrhoea Cryptomenorrhea -A condition where menstrual
products are prevented from exiting the body by a partial or complete obstruction. 


Dyspareunia Female infertility Haematocolpos- An accumulation of menstrual blood
in the vagina

Haematometra -An accumulation of blood in the uterus Hematosalpinx Hydrometrocolpos -accumulation of secretions in the
vagina and uterus

Abdominal and pelvic ultrasonography and MRI  .  Physical exam Laboratory studies are not necessary in the evaluation and treatment of imperforate hymen.

TREATMENT  Medical therapy has no role in the management of imperforate hymen SURGICAL MANAGEMENT   Hymen incision .


an absence or one or both Fallopian tubes.  The vagina may be totally absent. total absence or a rudiment in the location of the uterus. . or represented by a rudimentary pouch of up to one half to three quarters of an inch deep.CONGENITAL ABSENCE OF THE VAGINA  The usual lesion consists:    absence of the middle and upper vagina.

Vaginal agenesis .

deriving from the urogenital sinus. The sex chromatin pattern is female. endocrine system is not affected. are normal.CONGENITAL ABSENCE OF THE VAGINA        is a rare anomaly. Referred to as ROKITANSKY-KUSTER-HAUSER SYNDROME The external genitalia and vestibule. 1: 5000 birth Known also as aplasia or dysplasia of the Müllerian (paramesonephric) ducts. Ovarian function is normal .


Cause : 

UNKNOWN no known gene is linked to this condition.

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


Treatment : Surgical 

Vaginal reconstruction 

modified McIndoe vaginoplasty 


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

vaginal septum is a congenital partition within the vagina; such a septum could be either longitudinal or transverse.

  A longitudinal vaginal septum develops during embryogenesis when there is an incomplete fusion of the lower parts of the two mullerian ducts. As a result there is a double vagina. .

.Transverse vaginal septum   is a horizontal "wall" of tissue that has formed during embryologic development and essentially creates a blockage of the vagina. It can occur at many different levels of the vagina.

or fenestration. although the periods may last longer than the normal 4-7 day cycle. . within the transverse vaginal septum so they may have regular menstrual periods.Transverse vaginal septum  large percentage of women with a transverse vaginal septum have a small hole.

Transverse vaginal septum  complete obstruction without a hole within the transverse vaginal septum  when having menstrual cycles there will be a blockage of blood which will collect in the upper vagina .


Manual dilatation or surgical excision 

require a surgical procedure to resect the fibrous septal tissue stenosis or scarring of the vagina in the area of the transverse vaginal septum which can create an "hour-glass" effect in the vagina. 


Nursing care: 

Informed consent of procedure Patient Education  

Teach patient that after resection of the transverse vaginal septum, she is required to use a vaginal dilator in order to avoid this "hour-glass" effect of the healing process. Once the transverse vaginal septum has been surgically corrected, tell her that she can be able to have normal sexual relations and should also have no long-term effects on reproductive function and the ability to have a child. 

Emotional support



The womb or uterus is a pear-shaped organ, tucked away in your pelvis. It is 7.5cm long, 5cm wide and 2.5cm in depth. Inside, it is hollow with thick muscular walls. The lower third of the uterus hangs down into the vagina and is called the cervix. The upper portion is called the fundus and this is where the fertilized egg grows into a baby.

Many women will have an abnormality without ever knowing anything about it.1-3.2 % of women have a uterine abnormality. Approximately 0. because it has no effect on their fertility or on their ability to give birth. .

. Class II: Unicornuate uterus (a one-sided uterus). (double uterus). Class IV: Bicornuate uterus (uterus with two horns). Class III: Uterus didelphys.Uterine malformation Types classification:     Class I: Mullerian agenesis (absent uterus).

 The uterine cavity has a "T-shape" as a result of fetal exposure to diethylstilbestrol.  Class V: Septated uterus (uterine septum or partition). Class VI: DES uterus. .


very rare condition. she usually has two ovaries . A unicornuate uterus is just half the size of a normal UTERUS and the woman has only one fallopian tube. However.unicornuate uterus    (a womb with one 'horn') happens when the tissue that forms the womb does not develop properly.

Unicornuate uterus  is smaller than a typical uterus and usually has only one functioning fallopian tube.  a second smaller hemi-uterus which is obstructed . The other side of the uterus may have what is called a rudimentary horn.

 If the rudimentary horn is obstructed. a full-term pregnancy is believed to be possible . painful menses/perimenstrual pain  obstructed uterus does not have a means for the blood to Regress or leave the body.  S/s   an enlarging pelvic mass. This can result in pain.  If the contralateral healthy horn is almost fully developed.

Unicornuate uterus Most of the time it does not cause any gynecologic or obstetric problem .

Unicornuate uterus .

.DIAGNOSTIC  Imaging studies     Hysterosalpingography (HSG). allows evaluation of the uterine cavity and tubal patency Hysteroscopy three-dimensional ultrasound laparoscopy might also be used to confirm the diagnosis. performed under fluoroscopy.

RISK  PRETERM LABOR-is thought to be because of space restrictions. . the growth of the baby might trigger early labor. because a unicornuate uterus is smaller than a typical uterus. term birth in only 45%. MISCARRIAGE-due to abnormalities in the blood supply of the unicornuate uterus that might interfere with the functioning of the placenta ECTOPIC PREGNANCY      miscarriage in 37% preterm birth in 16%.

MANAGEMENT   The resection of the obstructed hemi-uterus can be performed laparoscopically. Nursing management:     Informed consent Explain the procedure Monitor vital sign Emotional support .

uterus is heart-shaped with two joined cavities whereas a typical uterus has a single cavity. .BICORNUATE UTERUS a type of congenital uterine malformation (müllerian duct abnormality).

. it can happen for unknown reasons.Cause   This can happen to women whose mothers took a medication called DES during pregnancy.

.Diagnosing Bicornuate    hysterosalpingogram (HSG) hysteroscopy but diagnosis should be confirmed with a three-dimensional ultrasound or laparoscopy.

so the risk may vary for each woman. .Risk    preterm labor cervical insufficiency many women with bicornuate uteri carry pregnancies to full term without any problems.

a stitch placed in the cervix to stop premature dilation .Management   reconstructive laparoscopic cervical cerclage.

hollow organ the uterus. As the fetus develops. Instead. This condition is called double uterus (uterus didelphys). the tubes don't join completely. . the uterus starts out as two small tubes. however. each one develops into a separate cavity. the tubes normally join to create one larger. Sometimes.Double uterus   Definition In a female fetus.

occurs in 2 %t to 4 % of women who have normal pregnancies. Double uterus is rare ² and sometimes not even diagnosed. Treatment is needed only if a double uterus causes symptoms or complications. . such as pelvic pain or repeated miscarriages.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. The percentage may be higher in women with a history of miscarriage or premature birth.


such as blood flow despite the use of a tampon . Possible signs and symptoms may include:    A mass in the pelvis Unusual pain before or during a menstrual period Abnormal bleeding during a period.Symptoms   Some women have a double uterus and never realize it ² even during pregnancy and childbirth.

Causes   Unknown . The condition is associated with kidney abnormalities. . which suggests that something may influence the development of these related tubes before birth.

Then X-rays are taken to determine the shape and size of the uterus. Ultrasound. a special dye is injected into the uterus through the cervix. . Magnetic resonance imaging (MRI). Hysterosalpingography.Tests and diagnosis     routine pelvic exam observes a double cervix or an unusually shaped uterus.

With this surgical procedure. This allows to examine the inside of the uterus. inserts a tiny tube with a light into the vagina and through the cervix. Laparoscopy requires general anesthesia. fiber-optic device ² into the abdomen to examine the uterus. .  Hysteroscopy. a small incision beneath the navel and inserts a laparoscope ² an illuminated. Laparoscopy.

A double uterus may also cause premature birth or unusual positions of the baby in the uterus. pregnancies and deliveries. .Complications    Many women with a double uterus have normal sex lives. sometimes a double uterus leads to infertility or miscarriage. such as breech presentation.

treatment is rarely needed. Surgery to unite a double uterus is rarely done ² although other surgical procedures may help partial division within the uterus.Nursing Care  Patient Education    If you have a double uterus but no signs or symptoms. Advised importance of prenatal care to prevent Preterm labor or miscarriage.  Emotional / psychological support .




 Cystocele ± protrusion of the bladder through the vaginal wall  Assessment ± interference with voiding and stress incontinence  Management includes Kegel¶s exercises. surgery (anterior colporrhaphy) to surgically shorten the muscles that support the bladder .

heaviness. and hemorrhoids . Rectocele ± protrusion of the rectum through the vaginal wall characterized by rectal pressure.

Herniation near the apex of the vagina between the major supporting uterosacral ligaments Symptoms      Abdominal pain Constipation Diarrhea Bowel obstruction Pelvic discomfort in presence of enterocoele due to downward traction of viscera . usually caused by past damage to the pelvic floor muscle.Enterocele    Prolapse of the small bowel into the wall of the vagina.


. congenital inadequacy of endopelvic connective tissue.Causes of Enterocoele     unknown although there seems to be an increased incidence associated with any other problems trauma during parturition. chronic constipation.

.Treatment  Prevention    pelvic floor exercises avoid chronic constipation and straining estrogen therapy pessaries (ring) replace prolapse to reduce edema and cure ulceration  Conservative     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].

fresh air regular hours of eating and sleeping regulation of the bowels and wholesome companionship with others.Enterocoele  Nursing care       well. agreeable. occupation. .ordered hygienic mode of living a nutritious and bland diet adequate mental and physical rest daily exercise .


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 . appear most often as firm bumps on the cervix's surface.Nabothian cyst         Common findings is a mucus-filled cyst on the surface of the uterine cervix. A woman may notice the cyst when inserting a diaphragm or cervical cap.

After menopause.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 sexual intercourse.  Treatment: removal of polyps . After douching.

Types: subserosal( external surface of the uterus intramural (within the myometrium) submucosal (with in the endometrial layer) . leiomyomas or myomas.Uterine fibroids    are noncancerous growths of the uterus that often appear during your childbearing years. Also called fibromyomas.

symptoms       Heavy menstrual bleeding Prolonged menstrual periods or bleeding between periods Pelvic pressure or pain Urinary incontinence or frequent urination Constipation Backache or leg pains .

two hormones that stimulate development of the uterine lining in preparation for pregnancy. such as insulin-like growth factor. . Substances that help the body maintain tissues. Many fibroids contain alterations in genes that code for uterine muscle cells. may affect fibroid growth. Fibroids contain more estrogen and estrogen receptors than do normal uterine muscle cells. Hormones. Estrogen and progesterone.CAUSE    Genetic alterations. appear to promote the growth of fibroids. Other chemicals.

DIAGNOSIS   Pelvic examination UTZ .


Treatment   Watchful waiting Medications They don't eliminate fibroids. Oral contraceptives or progestins can help control menstrual bleeding. but may shrink them. Androgens :Danazol. but they don't reduce fibroid size   Hysterectomy myomectomy . Medications include:    Gonadotropin-releasing hormone (Gn-RH) agonists.

skin or hair can be observed Endometriomas (chocolate cysts) . bone. teeth.(cystic teratomas) ± cartilage.Benign Ovarian masses    Ovarian cysts ± physiologic variations in menstrual cycle Dermoid cysts .

cramping.Manifestations Benign Ovarian masses  Sensation of fullness. 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 .


frequency of urination. constipation. tenesmus. blood in the stool  Dx: pap smear. hematuria. bladder spasm. surgery . biopsy  Mx: radiation.Vaginal Cancer  Upper 1/3 most common site  S/S: painless vaginal bleeding and discharge. urinary retention.

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 .

A speculum is placed in the vagina after the vulva is examined for any suspicious lesions . If no lesions are visible. legs in stirrups. an iodine solution may be applied to the cervix to help highlight areas of abnormality .Colposcopy is performed with the woman lying on her back. 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. and buttocks at the lower edge of the table (a position known as the dorsal lithotomy position).

Use of Tamoxifen. Multiparity 3. Use of unopposed estrogen 6. DM 4. decreases DNA synthesis and inhibits estrogen effects. Obesity 2. Early menarche and late menopause 8. HPN 5.is an orally active selective estrogen  receptor modulator (SERM). High fat diet 7. it acts as partial agonist on the endometrium .Endometrial Ca Postmenopausal Risk Factors: 1.

Manifestations:  Unusual bleeding. spotting. 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 . or other discharge  abnormal vaginal bleeding such as bleeding between periods or after menopause  In about 10% of cases.

2. including intra-abdominal metastases and/or inguinal lymph nodes IC IIA Stage II (grade 1. 2. or 3) IVB .Stage IA Stage I (grade 1. or 3) IIIB IIIC IVA Stage IV (grade 1. 2. 2. or 3) IIB IIIA Stage III (grade 1. or 3)* IB Characteristics Limited to the endometrium Invasion of less than one half of the myometrium Invasion of one half or more than one half of the myometrium Endocervical glandular involvement only Cervical stromal invasion Invades serosa and/or adnexa and/or positive peritoneal cytology Vaginal metastases Metastases to pelvic and/or para-aortic lymph nodes Invasion of bladder and/or bowel mucosa Distant metastases.

Ovarian Ca Risk Factors: Increased age (mean age 59 yrs old) Fertility drugs Early menarche or late menopause Asbestos and talc exposure S/sx: abdominal swelling or inc abdominal girth. pelvic pressure. bloating. mild constipation Management: surgery .

-End You better live your best and act your best and think your best today. is the sure preparation for tomorrows that follow -Matineau- . For today.

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