N104-MATERNALANDCHI

LDNURSI
NG glands.
c.unnecessar
yfear
sandbaf
fl
edt
hought
s
NURSI
NGCAREOFWOMENWI TH
DI
SORDERSOFTHEREPRODUCTIVESYSTEM Nur
singCar
ePr
inci
ples:
(
Gynecol
ogi
cNur
sing)
1.Hist
or yt aki ng–shoul di ncl ude:
Gy necologic– deriv
edf r
om theGr eekwords“
gyne”or a.Menst rual cy cle
“gynaikos”meaningwomanorf emale b.Mar it
al andsex ual hist or y
and“ logia”meaningstudy.Thus,gynecol
ogymeansthe c.Obst etrical hist ory
studyofdi seasesof women. d.Pr ev i
oussur ger i
esori llness
e.Bowel andur inar yassessment
Gy
necologyofInfancyandChi l
dhood–t heconceptof f.Associ atedor gansr ev i
ew
gynecologyincl
udesdev el
opment aldefects, g.Pr esent i
ngpr obl em
anomal i
esanddi seasesoft hereproductiv
e 2.Provisionofpr ivacy
organsinfemal esofallagesf r
om infantsto 3.Prevent ionofi nfect ion–useofst er il
eequi pment sfor
el
derlywomen.Thi sbroadenedconcept pel
vicexam
acknowledgesequal ri
ght sforyoungandol dal
ike, 4.Physical pr epar at i
on
especial
lyasappl i
edtopr event
iveandt herapeuti
c a.Posi tionanddr api ng
aspects.Pelvi
cev al
uationatanear l
yagemaynot 5.Psychol ogi cal Pr epar at i
on
onlybedesirablebutinsomecasesmay bea A. Nor mal ly, womenassoci at et heseor ganswi th
necessity
. femi ninityasi def r
om r epr oduct ivef unct i
onand
sex ual sy mbol i
sm.
Considerati
onsi nt heGy necologi calex am i
n B. Womenmayexper iencedi fficul tyi naccept ing
chil
dhood: mani pul at i
onoft heseor gansdur ingt estsand
1.Anatomi cconsi derati
onpl acesemphasi sont he treat ment s.
i
nfantil
eofsmal lsizeoft herepr oduct ive organs. C. Thenur sewhoi ssensi ti
v et ot hemanyt hought s
2.Specialtechniquesmayber equi r
edbecauseof andf ear s, feelingsofhumi liat ionandgui lt,
theimmat urityofther eproduct i
ve organs. embar rassmentandangert hatmayt roubl et he
3.Theexam mayhav epossi bleemot ionaleffect
, pat ienti sbet terpr epar edt ohel pheracceptt he
bothimmedi at eandi nthef uture.Par ental necessar ymedi cal exam.
react
ionshav emucht odowi ththis. D. I tof tenr eassur est hepat ientt hatmedi cal
4.Thenur seshoul dhav epat ience, reassurance i
nf or mat ionwi l
l begi v enonl yt ot hedoct orand
andav oi
dt hingsthatwi llli
kelycausepai n. goesnof urther .
E. Thepat ientshoul dknowt hatcompl et e, frank
Gy
necologicGeri
atr
ics–r ef
erst
ochangesi
nthe answer st ot hequest ionsoft hedoct orwi l
l help
reproduct
iveorgansduetoagi
ng. consi der abl yindet er mi ni ngt hecauseofany
difficul t
yi npl anni ngsui tabl et reat ment .
1.Menopause–cessat
ionofmenstr
uat
ion, F. Thewomanshoul dbepr epar edf ort he
“changei
nli
fe”orgr
andcl
imact
eri
c quest ionsshewi llbeasked: likemont hl y
per iods, pr egnanci es, del iv er ies, et c
2.Phy sicalChanges: G. Sheshoul dbegi v enachancet ot hinkt hrough
a.gr adualatrophyofthereproducti
vetract heranswer sunderl esspr essur eandt husgi ve
b.v ulvalosescontourandtumescence mor eaccur atei nf or mat i
on.
c.labiashr i
nks H.Expl ai ntot hepat i
entt hepr ocedur et hatwi llbe
d.v aginalmucosabecomest hinnerandsmooth per for med, whatshei sex pect edt odoandwhat
e.ut erusgetssmal l
erandfi
rm thedoct orwi lldo.
f.ov ari
esbecomesmal l
,fi
rm andatrophic I. Acal m, thought f ul,inter est ed, yetmat teroff act
g.br eastsloseful
lnessandrevealsatr
ophyand mannerof tenhel pspat ientt obeatease.The
shrinkage nur seshoul dhowev erappr aiseeachpat ientand
adj ustherappr oachaccor di ngl y.
3.Subj
ect
ivesy
mpt
oms: J. Reassur et hepat ientt hatt henur sewi llbe
presentdur ingt heent i
repr ocedur e.
a.hotfl
ushes–especi al
lyatnightdueto K. Vent il
at i
onsessi onsmaypr ov idet henur sean
vasomot orphenomenal imit
edt otheupperpart oppor t
uni tyt ocl ar i
f ymi sconcept iont hatt he
ofthethorax,headandneck.Thi sisusual l
y pat ientmayhav e.Someexampl esar e:
fol
lowedbyr ednessoft heskinandper spir
ati
on.  Remov al ofut erusmeansi nduct ionof
Thismaybecont r
oll
edbyt heuseofest r
ogen, menopause
sedati
vesorbot h.  Ar adical hy ster ect omy(wi thout
b.menopausal dyspareunia–duet ot hi
nningof vagi noanat omy)meanst hatone’ s
thevaginalmucosaanddecr easedfunctionof sexual l
ifei st er mi nat ed
themucussecr eti
ngcer vi
xandBar tholi
n’s  Remov al oft her epr oduct i
v eor gans
1
 makesawomanl esswomanl y  Av oi
dheav yli
fti
ng
 Remov al oftheovaryproducessteril
i
ty  Cer vi
calpacki
ngr emainsinplaceandr emoved
 Suspi ciousPap’ ssmearpositi
vely after24hour s
est
abli
shest hediagnosi
sofmal ignancy  Sexual act
ivi
tyisresumedwi thdoctor’
sorder
L.Ever
yeffort
stomai ntainthepati
ent’
sprivacy,t
o usually2-3weeksaf ter
underst
andheremot ional
li
abil
it
yandt olist
en  Compl eteepit
helial
izat
ionisexpectedin2-3
toherexpressi
onofneedsmustcont inue. mont hs
 Increaseinvaginalsecret
ionsisexpectedfor2-
GYNECOLOGI
CPROCEDURES 3day s

1.Di agnost ic D.Culdoscopy–v i

sual
izationoft heinternal
A.Schi ll
er’st est–f orCa repr
oductiveor gansbyi nsertingat ubularli
ghted
-cervixispai ntedwi t htinct ureofi odine i
nstrument( culdoscope)t hroughani ncisionmadei nt
he
-colorchangei nt hecer vixisnot ed poster
iorfornixoft hevaginai ntot hecul -
de-sacof
Mahoganybr ownst ain– Douglas.
negat i
ver esul t Preparat
ions: Kneechest
Nost ai ning–posi ti
v er esul t Homecar ei
nst ruct
ions:
B.Papani colaut est–cy tologi ct estf orCa  Nodouchesandsex ual act i
vit
yf or1week
Uses: Todet ectpr ecancer ousl esions  Wat choutf orcompl i
cationsl i
kei nf
ection,
Todet ectr ecur renceofCa hemor rhageandai rembol i
sm
Toev aluat eendomet rialst atus  Thei ncisi
onshoul dheal rapidly
Subj ect s: Women20y ear sabov e
Sexual lyact ivewomen–done E.Lapar oscopy–abdomeni sinsuffl
atedwithCO2anda
regul arly tr
ocari sintroducedt hr
oughthelowerporti
onoft he
Pr epar ations: Nosex ual act i
vitydur ing umbi l
icus.Al aparoscopeisi
nsertedandpelvicorgans
preceedi ng24hour s arevisualized.Thisisadiagnost
icaidtodetermine
Nol ubr icantused ectopicpr egnancy,infl
ammatorydiseaseandov ari
an
Nov agi nal t
abl etsf or2- 3ni ghts neoplasms.
befor e
Noper ineal douchebef oret he F.Hy stero-Sal pingogram –X- raystudyoftheut erusand
exam thef al
lopiant ubesaf tert heinject
ionofacont rast
Pr ocedur e: Aspi rat eorswabv agi nal medi um t hrought hecer vi
xv i
aacannul a(indigo-
secr etionsf r
om t hepost eriorf ornixandmakea carmi nedy e)
smearont hegl asswi t hlight Purposes:
roll
ingmot i
on.Donotl etsmearbecome  St udypr oblemsofst eri
li
ty
dr y,immer sei mmedi at el
yi na  Ev al uatet ubal patency
fi
xingsol ut i
onofet hanol 95%  Det ermi nethepr esenceofut eri
nepat hology
Resul t
: Has90- 95%accur acyf or Position: Lithotomy
cervical Ca Result:Iftubesar epat entthedy ecanbev i
sualized
70- 75%accur acyf orsev er e passingoutt hef i
mbr iatedendoft he
dyspl asia fal
lopiant ubes.
80%accur acyf orendomet ri
al
Ca G.Rubi n’
st est–determinetubalpatency.CO2is
Cl ass1–absenceofat y
pi calor passedt hrought hecervi
xintotheuterusandtubes.If
abnor mal cells patent,gaswi ll
passt hr
ought hefi
mbr i
atedendsoft he
Cl ass2–at y pical cy tologybut fal
lopiantubesi ntotheperi
tonealcavi
tyandwi l
lgiv
ea
noev idenceofmal i
gnancy sensationoff ull
nessandspasmodi cshoulderpains
Cl ass3–cy tologysuggest ive duet osever eir
rit
ati
onfrom thegas.
butnotconcl usiv eofmal ignancy
Cl ass4–cy tologyst rongl y H.Sim’s-Hunner’
stest–postcoi t
alexam –aspecimen
suggestCa ofseminal f
lui
dfrom poster
iorfor
nixandcer
vical
canal
Cl ass5–cy tologyi sconcl usive i
saspi r
ated2-4hoursaf t
ercoit
us.
ofCa Purposes: Testforcompat i
bil
i
tyofsper
mswi th
Not e: Class1- 4 cer
v i
calmucus
addit i
onal diagnost i
cex amsasbi opsyandD&D Determinehusband’sabi
li
tyt
odeposit
C.Cer vical biopsyandCaut eri
z at i
on–r emov al ofsmal l normal moti
lespermsinsuf f
ici
ent
bitsoft i
ssuef rom t hecer vixf ordi agnost icpur poses. amount
Elect rocaut erizat i
oni sdoneaf ter war dst ocont rol
bleedi ngf rom t hesi t
eort or emov eaddi ti
onal tissue. I
.Semenanal
ysi
s–exami
nat
ionoft
hesemenf
or
PostBi opsyi nstr ucti
ons: numberandmot
il
it
y
 Av oidheav ywor kfor24hour s
2
J.Ult
rasound–si mple,safeandi nexpensiv
eprocedure GYNECOLOGI
CDI
SORDERS
whichcausesorusessoundwav esofatransducerand
scanoscill
oscope. I
.Menst
rual
Dysf
unct
ions
Purpose: Todetermi netumororcy stsor
ret
roperi
tonealmasses A.Amenor rhea–absenceofmenst ruationany ti
me
Limit
ati
ons: Techni caldif
ficul
tyinfatorobese betweenpuber t
yandmenopause( not
pati
entscouldbealteredbynoneorgas adi seasebutasy mpt om)
int
erference. 1.Pr imar y–f ailureofmenst ruationt oappear
i
ni ti
allyatpuber ty
K.Comput er
izedTomogr aphy–i nsteadofjustasingle 2.Secondar y–cessat ionofmenst ruationaf ter
X- r
aysour
ceandf il
m, t
hereisanX- raysourcemov i
ng menar che
aroundthepatientwit
hspeci al
det ectorsopposit
et heX a.Phy siologi c–nor mal absencebef orepuber t
y,
-raysour
ce.Thecomput ertranslatest heX-rayf
il
m duri
ngpr egnancy ,l
act ationand
takenonthepat i
entandprojectsi tont heHIVscreen. menopause
b.Cr ypt omenor rheaorPseudomenor r
hea–
INDIRECTFHRMONI TORI
NG menst ruat i
onoccur sbutdoesnot
Thi
si nv
olvesplaci
nganinstr
umentont he appearex t
ernal lybecauseof
pregnantabdoment hatFHRthr
oughut er
ineand obstruct i
oni nt hel owergeni tal
abdomi nalwall
.Itissimpl
etoapplyandcanbeused or gans
beforethemembr anesrupt
ureorifthecervi
xisdi
l
ated. c.Pat hol ogi cal –duet osomepat hological
Inst
rument sused: di
seasesoft her eproduct ivesy stem
1.Headst ethoscope B.Oligomenor rhea–r educt i
oni nfrequencyof
2.Ultr
asoundt ransducer–Dopplerpri
ncipl
e menst ruat ionorpr olongat i
onofi nterval abnor mally,
usual lyfrom 38day st o3mont hs
DIRECTFHRMONI TORI NG C.Pol ymenor r hea–i nterv alisshor tenedormor e
Byfetalelectr
ocardiography–pr esent
ingpart frequentoccur r
enceofmenses, usual l
yev ery20
aftermembr anesr upture day s
Risk: Scal pabscess, postpartum endometri
tis D.Hy pomenor rhea–scant ymenst rual fl
owwi t
hout
1.Decelerati
ons: t
ransientf
allofFHR relationt of requency
a.Earl
y ,nor
mal ,negati
v e–occursduring E.Hy per menor r
hea–orMenor rhagia–ex cessiv e
contracti
ons menst rual f l
ow
b.Late,abnormal ,posi
tive–30-40seconds F.Met ror r
hagi a–bl eedi ngorspot ti
ngwi t
houtobv i
ous
aftereachcont ract
ions=ut eroplacental relationt omenst rual cy cl
e.Al soknownas
i
nsuff
iciency i
nt ermenst rual bleedi ng.
c.Variable–unpr edict
able=cor dcompr essi
on G.Dy smenor rhea–pai nful menst r
uat ionwi t
hspast i
c,
crampyandcongest ivepai ns
NONSTRESSTEST Ty pes:
FHRi ncreasesinresponset
ofet
almovement
, 1.Pr imar yorI ntri
nsi c–onsetofpai near lyin
usesext ernalfetalmonit
or menst rual lifewi t
hi nher entorcongeni tal
Results: causes
Negat i
ve–React ive–FHRaccel
erat
esin 2.Secondar yorAcqui red( Extri
nsi c)–onsetofpai n
responset omov ement sev eral year saf termenar che
Positi
ve–NonReact ive–FHRdoesnot a.Membr anousdy smenor r
heal –causedbyt he
acceleratewithfetalmov ement remov al oft heendomet ri
um asonepi ecei nst eadof
breaki ngof forsl oughi ngof f.Alsoknownas
STRESSTEST “endomet rial cast ”.
1.Nipplesti
mul ationst resstest
2.Oxytoci
nchal lenget est(OCT)–Ox yt
ocin CAUSES
i
nf usedperI Vwi t
h1m. u.i nit
iall
yand
i
ncr easedev ery5-15mi nutesunt il3contracti
onsare A.Psychogeni c–unst ablenervoussy st
em orpsy chic
exper i
encedi n10mi nut es. tr
aumaespeci all
ywhenr elatedt omenst r
ual per
iod;
Indicatedf or: DM, Tox emi a,IUGR, Postterm,Rh l
ackofknowl edgeaboutsi gnificanceandnor malit
y
i
ncompat i
bil
it
y ofmenst rualfunctions.
Resul t
s: B.Constit
ut i
onal–r esultsf r
om di seasecondi tionsas
Negative–React i
v e–Nol atedecelerat
ions anemia, t
uberculosis,DM, ov erwor korf at
igue
Posit
ive–Nonr eact ive–Consi stentand C.Obstructiveoranat omi cal–causedbycer v i
cal
per si
stentlatedecelerations l
esions,stenosisoracut eant eflexionoftheut er
us
D.Endocrinef act
or s–i ncreasedest rogenwhi chisa
normal sti
mul antofut eri
necont racti
li
ty

3
TREATMENT I
V.Abnormal menstruat
ion
1.Precaci
ous–appear anceofmenar cheearl
yin
A.Endocr i
netherapy chi
ldhood,usual
lyunder9yearsofage, usual
ly
1.Useofest rogen–i nadequat edosagei near l
y passages,GImucousmembr anes,breast
s.Therei
s
partofthecy cletoconvertov ul
atorycycleto aquestionwhethertheycanber eal
lycall
edas
unovulatory(i
nhibit
ionof menstruati
on.
ovulat
ionbringsaboutr el
iefofpai n).
2.UseofPr ogest er
one–t osuppr essov ulat
ion,the ANOMALIESANDMALFORMATI
ONSOFTHE
drugisgivendur i
ngt hefi
rst25day sof REPRODUCTI
VEORGANS
thecycle.
B.Pre-sacral
neur ectony–givescompl eterel
iefofpain I
.Genit
al Anomal ies
i
n60- 70%pat ientcases. A. Var iationi nsi z eoft hel abi ami nor a–one
labi um i sl ar gert hant heot her .
B. Aggl ut inat ionoft hel abi a–l abi ami nor aand
C.Treatmentduri
ngattacks: labi amaj or aar ehel dt oget heri nt hemi dli
neby
1.l
ocaluseofheat denseadhesi ons.
2.anal
gesics 1.Compl et e
3.anti
spasmodics 2.I ncompl et e–sy nechi av ul vae
D.Psychotherapy C. Imper for at ehy men–absenceofhy menal
openi ng.Thi sisusual l
yt reat edwi thexci sionof
POSSI
BLECAUSESOFMENSTRUALDYSFUNCTI ONS thehy menundergener al anest hesi a.
A. Neur ogenic–or ganiclesionoridiopat hi
c D. Rigi dhy men–t hehy menal openi ngi snor mal
hypot halamicdy sfunct i
on butt hemembr anei susual lyf ir
m gi v i
ngr iset o
B. Pit
uitary–i nsufficiencyofhor mones, tumorsor dy spaneur ia.
congeni taldefect E. Congeni t al absenceoft hev agina–usual ly
C. Psychogeni c–mi norormaj orpsy chosis associ at edwi tht hheabsenceoft heut erusand
D. Chroni cill
ness wi thanomal iesoft heur inar yt r
act .Al sot ermed
E. Met abolicdiseasesoft hepancreas, thyr
oidand “genesi soft hev agi na” .
adrenal s F. Vagi nal anusor“ atresi aani vagi nal is”–anus
F. Nutriti
onal di
sturbancesl i
kemal nutri
tion andt hebowel sopeni nt ot hev agi na.Sur gical
G. Ovar i
an–asi nt umor sorcongeni taldefects cor r ect i
oni snecessar y .
H.Congeni talcauses–l ikeimperforatehy men, G. Absenceoft heut erus–occur swi thabsenceof
absenceofv aginal septum (gynatresis) thev agi na.
I
. Tr aumat ic–l i
kest enosisofvaginaorcer vi
x H.Doubl eorsept at ev agi na–v aginalcanal is
duet ot r
auma separ atedi nt ot wobyasept um.Mayoccurwi t
h
ent irel ynor mal uter usandf al l
opi ant ube.I tis
GENERALMETHODSOFTREATMENT gener allyasy mpt omat icunt i
l mar r i
agewheni tis
Eachpati
entmustbet reatedaccor dingtoetiologi
c foundt ocausedy spaneur i
a.Ex cisionoft he
fact
or. sept um i sdone.
A. Steroidtherapy–desi gnedtot r
iggerpitui
tar
y I. Inf ant ileut er us–pr esenceofi mmat ureut erus.
functions J. Uni cor nat eut er us–ut er ushasonl yonehor nor
B. Gonadot ropictherapy–desi gnedt oreplace openi ngi nt ot hef allopiant ubescausedbyt he
pit
uitaryhormones dev elopmentofonl yoneMul lerial tube.Abi li
tyto
C. Clomi phenetherapy–st imulat
epi t
uitaryact
ivi
ty concei v edependsupont hemat urityoft he
throught hehypothal amus uni cor nat eut erus.
D. Hy pothalamichormonest imulati
onwhi ch K. Bicar nat eut er us–t heupperpor tionoff undus
dir
ect l
yst i
mulatesy nthesisandr el
easeof oft heut er usi sdi v idedi nt ot wosepar atehor ns,
pit
uitarygonadot r
opi ns(underresearch) thel owerpor ti
onf usedt of orm onl yonecer vi
x.
E. Goodnut ri
ti
on L. Ut er usdi del phy s–ordoubl eut erus–cer v i
xand
vagi naduet ot hepr esenceofacompl ete
II
.Dysfuncti
onalUteri
neBl eedi
ng sept um i nt hemi dl ine--------
----
--
-Abnormal bl
eedingf r
om theuteri
neassociated M.Ut er inedi spl acement s:
withtumorandi nf
lammat ions.Iti
sapttooccuratt he 1.Ant ef lex ion–bendi ngf or war doft hebodyof
extr
emesofmenst ruall
if
e.Maj orcauseisincreasein theut er ususual l
yseeni nsmal l
endomet r
iall
ini
ngoft heuterusorendomet ri
al under dev elopedor gan.
hyperpl
asia. Cause:Gonadal def iciency
Cues: Cr ampydy smenor rheal
I
II
.Unov
ulator
yBleeding St er ili
ty
-Fol
li
cledevel
opsbuti
nst
eadofmat ur
ati
on Del ay edmenar che
becomescysticandt
hendegener
ates. Management : St i
mul at ionofgr owt hoft he
ut er us, di lat ationofcer vical canal and
4
 cur
ett
age. causesv aginal
rel
axation.
2.Ret rodispl
acement s–backwar d Types:
displacementoft heut er us a.Firstdegr ee–whent hecer vixofthe
Ty pes: uter
uspoi ntsint heax isofthev agina
a.Ret rov er sion–ut erusi st ilted b.Seconddegr ee–t hecer vi
xi sator
backwar doni tst ransv erseax isagr eat erorl ess nearthei ntroitus
degr eewi th c.Thir ddegr ee–“ procedentiaut eri
”,
forwar drotationoft hecer vix. cervi
xpr otruseswel lbeyondt hev aginal
b.Ret roflexi on–backwar dbendi ngof surf
ace.
theut eruswi tht hecer v ixinusual Cues:
posi ti
on. a.discomf or tduetomechani cal
c.Ret rocessi on–backwar dbendi ngof prot
rusionoft heut erus
theut eruswi thoutr ot at ionorbendi ng b.somedegr eeofbear ingdownand
Causes: heavinessi nt helowerabdomenand
a.Congeni tal –obser vedi nut er usof backacheduet otractionont he
v
eryy
ounggi rls uter
inel i
gament saswel lasv enous
b.Acqui red congest i
onpr oducedbyt he
 Puer per al–duet oi ncr eased prol
apsed
st rainonsuppor tingl igament s
thatwhent heut erusi nv olutes, c.ur
inar
yinconti
nence
theov erst r etchedl igament s d.pelvi
cdrag
cannol ongermai nt aini tin e.consti
pati
on
nor mal posi tion. f.gener
alfati
gue
 Adr enal diseases–l i
ke
i
nf lammat or yorendomet ri
oses Tr
eatment:will
dependupon:
 Neopl asms–asi nl ar geut erine a. age
my omaswhi chpushest he b. mar i
talst
atus
ut erusbackwar dori nov ar i
an c. generalhealth
tumorl ocat edov ert heut erine d. degreeofpr ol
apse
body . e. presenceorabsenceofassoci
atedpat
hol
ogi
cal
 Tr aumaasi nsuddenf al ls conditi
ons
 Ful l bladderandr ect um
 I nt ra-abdomi nal pr essur e Tr
eatmentmaycomei nthef orm of :
 I ncr easedpel victilt a. sur
gery
 Var i
at ioni nl engt hofv agi nal 1. v aginal hy sterectomy -suitabl ef or
wal ls almostmassi vedegr eeofpr olapse
Cues: 2. Manchest eroper ation–donef orlesser
a.backache degr eepfpr ol
apseespeci all
yt hose
b.dy smenor rheal associ atedwi thlar gecy stocel e.This
c.fatigue involvescer v i
calamput ation.
d.bladderi rritat i
on 3. Col pocl eisis( Lef or toper ation) -closing
e.const ipat ion thev aginai noccasi onal casesof
Treatment  
: massi v epr ocedent ia.Thi sisper formed
a.Post ur al –knee- chestposi ti
onwhi ch onlyi ntheel derlyorwi dow.Pr ecededby
causesai rt odi stendt hev agi nat oal l
ow vaginal hy sterectomy .Usual lydoneasa
thefreel ymov abl eut er ust of all towar ds lastresor t.
thefront . b. Non-surgical
b.Binomi al posi ti
onandmai ntai ned 1. Pessar yTr eatment–madeofpl astic,
afterwar dswi t
hapessar y soft,handr ubbercomi ngi ndi fferent
c.Sur gical –shor teni ngoft her ound shapest of ittheneedsoft hepat i
ent
andsacr out er i
nel i
gament s Carepr iortouse:
- washwi t
hsoapandwat er,
3.Prol
apseoft heuterus–t hisi
smor e soaki nat i-
sept icsol ut i
onf or
fr
equentlyfoundinelder l
ywoment haninyoung 1hour
pati
ent
s. - doct orshoul dassess
Causes: condi ti
onofpat i
entbef orei t
s
a.I
ncreasinglax i
tyandat onyof insertion
muscularstructur
esinl aterli
fe Car edur i
ngi tsuse:
b.Overstr
etchingoft hepelvi
cfloor - t hepat ientshoul dbeawar e
especi
allyofthecardinalligamentswhich thati tpr oducesani ncr easei n
5
 vaginal dischar geand ovariesbutt heexternalgeni t
ali
a
asympt omat i
cirr
itati
on resembl ethatofthemal eduet o
- dail
ycl eansi ngv aginal douche abnor maldev el
opment .Clitori
sis
i
sr equired hyper t
rophiedandl ooksliket hemal e
- thepat ientshoul dr eturnto penis,secondar ysexcharact eri
st i
csand
thedoct oraf t
eroneweekf or ment alatt
itudeisthatoft hemal e.
re-
ev al
uat ion.Iffoundf it
,the b. Male–mor efrequentessent ialsex
doctorwi l
l l
etpat i
entweari t organsandt hetestesbutt hesecondar y
continuousl yandt ell
hert o sexchar acteri
sti
csandat titudear ethat
ret
urnagai nf orregularcheck- ofthef emal e.
up
 I nel derlywoman, when Thet r
uesexcannotbeeasilydet
ermi
ned
oper at i
onisnotf easibl
e, exceptthr
oughanuclearsexchromati
npatter
n
useofpessar ymaybe observedint
hesmearofcel l
stakenfr
om the
desi rableforan epit
heli
um ofthemouth,vagi
naorskinst
ained
i
ndef ini
teper i
odoft i
me bythePap’ssmeartechni
que
 I ny oungwoman, useof
pessar yusuallyisa 2.Hermaphroditi
sm-combi nedex ist
enceinthe
tempor arymeasur e. sameper sonofbot ht hemal eandf emalesex
 Ty pesofpessar y: glandscommonl yassoci atewi thmalfor
mat ion
i
. har d ofthereproducti
veor gans
rubber a. muscul inizi
nginfluence–
ri
ng hypertrophiedclitori
s,musculine
ii
. sof t distr
ibutionofbodyhai r
,masculine
rubber typeofbodyconf i
gurati
onandl ow
ri
ngs voice
iii
. har d b. Femi ni
zingchar acteri
sti
cs–
rubber rudiment aryvaginaandut er
usand
cap presenceofov ari
ant i
ssue.Thisis
iv. Menge’ rare
s
pessary 3. I
nf er
ti
li
ty–inabil
it
ytoachi ev e
v. Gl ass pregnancywithi
nast i
pulatedper i
odof
ball ti
meusual l
yoney ear
a. Pr imar y–t he
2. Vagi nalPacking–occassi onalyisused coupl ehas
togi vetempor aryreli
efi ncasesof nev erpr oduced
uterinepr ol
apse anof fspringor
Associatedanomal i
eswi thpr olapse: hasnev er
a.Cy stocele–occur sasar esultofa concei ved
defecti nthepubocer v i
cal fi
scialpl ane b. Rel at i
v eor
whi chsuppor tsthebl adderant erior l
y secondar y–
andt endst oper mitthebl addert osag inabi l
ityto
downandbey ondt heut er
usand concei ve
somet i
mesoutoft hev agina. followi ngt he
b.Rect ocele–r esultsf rom simi l
ar birthofachi l
d
mechani sm i
nv ol
vingt hepar arect al ordi fficultyin
fasciawi thadeeppost eri
orper it
oneal achi ev i
ng
fasciawhi chmaybedr awnf arther anot her
downwar dalongt heant er
iorsur faceof pr egnancyaf ter
ther ectum apr ev ious
concept ion.
Treatment: c. Absol ute–
Colpoperi
neorrhapy pr egnancyi s
Anteri
or–forcy
ctocele for ev er
Posteri
or–forr
ectocel
e impossi ble
Steri
li
ty–term usedonlyfori ndividual
F.Her
maphrodi
ti
sm whohassomeabsol utef act or
1.
Pseudoher
maphrodi
tism –mostcommon preventi
ngprocreat
ion.
ty
pe
a. Female–essenti
alsexgl
andsar
ethe
6
Fact
orsnecessar
yfornor
mal
concept
iont
otakepl
ace 4. uterinedispl
acement
5. Gener aldebi
li
tyl
iker
enalandcar
diac
1.Theov ariesmustpr oduceatr egulari
nter
v al
snormal disease
ovaandhor monei nsuf fi
cientquanti
tyforf
ost er 6. disturbedendocri
nefunct
ions
i
mpl antation 7. faultydiet–VitCandE
2.Thef emal ereproductivetractmustbepat entand
normallyfor med Di
agnosis:
3.Thetest esoft hemal eshoul dbeproducinghealthy 1. Thoroughhi stor yincludingmar i
talhistory
spermsofsuf f
icientamountandmot il
it
yforferti
li
zat
ion 2. Compl et
ephy sical esam ofbot hhusbandand
oftheov um wife
4.Thesper msshoul dbedeposi tednearenought othe 3. Assessmentofov ulati
on
cervi
cal canal sot hattheyt r
aversetheuter
inecanal t
o - BBT
meett heov um - Spi nnbar kheit
5.Boththemal eandf emalemustbei ngoodheal t
hy 4. Uri
netestf oradequat el
ev elsofpi t
uitary
conditi
on gonadotopins( FSHandest ri
ol)
st
5. Endomet r
ial biopsydoneont he21 dayoft he
Sper
m Anal
ysis menstrualcy clet odet erminei fsecretoryphase
Thesperm canbeexami nedont hebasi sof: i
soccur r
ing
1. quali
tyint ermsofcont ent 6. Rubin’
stestt ocheckf ortubal patency
2. easeatwhi chconcept ionis 7. hyster
osalpingogr am
att
ained 8. Sim’sHuhner ’
st est
Qualit
yisgoodi f
: 9. Semenanal ysis–f orqualityandmot i
li
ty
- v olume/ ej
acul ati
on–3- 5ml
- numberofsper ms/ ml –60- Treatment:
120Mi ll
ion 1. Surger y
- 60- 80%ar eact i
velymot i
lea a.tor eleaseadhesi onsofduct sand
twohouri nterv al reconst
ructionoft heduct s
- 85%sper m cells/ejacul
ation b.todi latest enosedduct sliket hecervix
arenor mal inf orm c.tubo- plast y–mai nt ai
npat encyoff all
opian
tubest hr ought hei nsertionofpol yethyl
ene
Et
iol
ogy tubesi ntot hem
Causesi
nt heMal e( 40%) d.arti
ficial f
imbr aeuseofpl ast i
clikecapf i
tted
1. Infectionwhi chmayobl i
teratet hemai nsex att
heendoft het ube
duct s 2. Alphaamy l
ase–i ntroducedi ntothev aginapost
2. Traumaori njury–whi chmaycl oset heduct s -coi
talluy
3. Toxi ccondi ti
ons–whi chmaydev it
alizethe 3. Hormonet herapy
germ cel l - Cl omipheneorCl omid–
4. Sev erei l
lness–l eadingt ophy sicalex haustion st i
mul atedt hehy pothalamus
andi mpot ence toi nactivet hepi t
uit
ary
5. Insuf fi
cientsper m count–causedby : gonadot ropinsmadef rom
- di seasel ikeor chit
isa frozendr i
edhumanpi tuit
ari
es
compl i
cationofmumps 4. Appr opr i
at ediet,sleepandr ecreation
- anomal i
esofr eproductiv
e
tr
act I
nf l
ammat oryandInfectiousPr obl
ems
- i diopathict ubul aratrophy– 1.,Leukorr
hea–anydi schar gef r
om thev aginawhichis
l
easingt oaz osper mia notbloody
6. Impot enceandpr emat ureofej acul ati
on– Normal –duringov ulati
onwithapHof4. 7
whi hcmayi nt erferewi ththedeposi ti
onoft he (acidi
c)
sper msi nt hev agi nalcanal Abnormal–i fcopi ousi namount ,malodorous
7. Acci dent aldi vi
dionoft hesper mat i
ccor d–as withabnormal color ,causesi
r r
it
at i
onand
whatmayi nterfer einsur geriesl i
keher ni
orraphy rednessofthev ulva, accompani edbybur ning
8. Faul tydiet–especi all
ydef i
ciencyi nVi tCandE sensati
onandf requentur i
nat
ionwi thdiscomfort
andpaininthel owerabdomi nal regi
on.
Causesi
nFemal e(60%)
1. I
nfecti
onlikeendometr
it
iswhichmayobst ruct Thi
smaybecausedby :
thetubes - f orei
gnbody
2. I
mmat ur
it
yoftherepr
oducti
veor gans - i nfect i
on( gonorrhea,post-
3. Anomal i
esoftherepr
oducti
veor gansl
ike: partalinfecti
on,moniliasi
s,
- i mperf
oratehy ment tri
chomonas, yeast)
- absenceofv agina - cer vicalandut er
inedisease
- t umors (polyps)
7
 Tr
eat
ment
:
- Vinegardoucheorplai
nwat er
(nostrongacidsorchemicals)
- Treatmentofspecif
iccausei f
diagnosed

2.
Pelvi
cInflammat or yDisease( PID)-ascendinginfecti
on
af
terhavingi nvolvedt heuppergeni taltract
Causes:streptococcus, staphy l
ococcusorgonococcus
Symptoms:
Local -acut e,sharpandsev erepainobbot h
sidesoft heabdomenorpel vi
saggr avat
edby
def ecation.Heav ypur ul
entdischargewithf oul
odoroccur s
Sy stemi c–gener al bodymal aise,f
everand
chills,anor exia,vomi t
ingandgener alaching

I
nfecti
onspreadsthr
oughbl
ood,
lymphat
icsandt
hrough
thegeni
tal
tract.
Treat
ment