GYNECOLOGIC DISORDERS

ENDOMETRIOSIS VAGINITIS & VULVOVAGINITIS

• Endometriosis is a disorder in which tissue similar to the tissue • Vaginitis is a medical term used to describe various
that forms the lining of your uterus grows outside of your disorders that cause infection or inflammation of the
uterine cavity vagina
• Endometrial tissue grows on your ovaries, bowel, and tissues • Vulvovaginitis refers to inflammation of both the vagina
lining your pelvis. It’s unusual for endometrial tissue to and vulva (the external female genitals)
spread beyond your pelvic region
• Endometrial tissue trapped in your pelvis can cause: • Causes
o Irritation o Organisms such as bacteria, yeast, or viruses
o Scar formation o Irritations from chemicals in creams, sprays, or even
o Adhesions, in which tissue binds your pelvic organs clothing
together o Sexual partners
o Severe pain during your periods o Vaginal dryness
o Fertility problems o Lack of estrogen

• Causes • Risk Factors

o Idiopathic o Recent treatment with antibiotics
o Retrograde menstruation o Uncontrolled diabetes
o Hormones transform o Pregnancy
o surgical scar o High-estrogen contraceptives
o Sexual intercourse during menstrual period o Disorders affecting the immune system (such as HIV
o Painful periods and organ transplantation)
o Pain in the lower abdomen before and during o Thyroid or endocrine disorders
menstruation o Corticosteroid therapy
o Cramps one or two weeks around menstruation o Vaginal douching
o Heavy menstrual bleeding or bleeding between
periods • The most common types of vaginitis
o Infertility o Candida or “yeast” vaginitis
o Pain following sexual intercourse o Bacterial vaginosis
o Discomfort with bowel movements o Trichomoniasis vaginitis
o Lower back pain that may occur at any time during o Chlamydia or gonorrhea vaginitis
your menstrual cycle o Viral vaginitis
o Non-infectious vaginitis
• Treatments o Atrophic vaginitis
o Pain medication
o Hormonal Therapy / Hormonal Contraceptive • Symptoms
o Laparoscopy/Surgery o The symptoms of vaginitis can vary depending on
o Hysterectomy what is causing the infection or inflammation
o Abnormal vaginal discharge with an unpleasant odor
o Burning feeling outside of the vagina during urination
ADENOMYOSIS o Itching around the outside of the vagina
• Adenomyosis is a condition in which the inner lining of the o Discomfort during intercourse
uterus (the endometrium) breaks through the muscle wall
of the uterus (the myometrium) • Treatment
o Menstrual cramps (dysmenorrhea) o Bacterial vaginitis – antibiotics metronidazole (Flagyl),
o Lower abdominal pressure or clindamycin
o Bloating before menstrual period o Fungal infection – butoconazole and clotrimazole
o Heavy periods (menorrhagia) o Cortisone cream to treat severe irritation
o Antihistamines – if the inflammation appears to stem
• Risk Factors from an allergic reaction
o 30 to 45 y/o o Topical estrogen cream – low estrogen levels
o Increase parity
o Early menarche PELVIC INFLAMATORY DISEASE (PID)
o Short menstrual cycle
o History of previous uterine surgeries (CS, D&C) • Pelvic inflammatory disease (PID) is an infection of the
o Antidepressant drugs (hyperprolactinemia) female reproductive organs. The pelvis is in the lower
abdomen and includes the fallopian tubes, ovaries, cervix,
• Treatment and the uterus
o Hormonal therapy (Progesterone / Estradiol)
o Pseudo pregnancy / false or fake pregnancy • Risk Factors
o NSAIDS o Having sex under the age of 25
o Surgery - Hysterectomy o Having multiple sex partners
o Having sex without a condom
o Recently having an intrauterine device (IUD) inserted
o Douching
o Having a history of pelvic inflammatory disease

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 • Sign & Symptoms
o Pain in the lower abdomen (the most common
symptom)
o Pain in the upper abdomen
o Fever
o Painful sex
o Painful urination
o Irregular bleeding
o Increased or foul-smelling vaginal discharge
o Tiredness
o Sharp pain in the abdomen
o Vomiting
o Fainting
o A high fever
• Pelvic ultrasound. This is an imaging test that uses sound
waves to create pictures of your internal organs
• Endometrial biopsy. In this outpatient procedure a doctor
removes and examines a small sample from the lining of
your uterus
• Laparoscopy. A laparoscopy is an outpatient procedure
where a doctor inserts a flexible instrument through an
incision in your abdomen and takes pictures of your pelvic
organs
• Prevention
o Practicing safe sex
o Getting tested for sexually transmitted infections
o Avoiding douches
o Wiping from front to back after using the bathroom to
stop bacteria from entering your vagina
• Complications
o Infertility, an inability to conceive a child
o Ectopic pregnancy, a pregnancy that occurs outside
the womb
o Chronic pelvic pain, pain in the lower abdomen
caused by scarring of the fallopian tubes and other
pelvic organs
• Recommended Parenteral Regimens
o Cefotetan 2 g IV every 12 hours PLUS
o Doxycycline 100 mg orally or IV every 12 hours OR
o Cefoxitin 2 g IV every 6 hours PLUS
o Doxycycline 100 mg orally or IV every 12 hours OR
o Clindamycin 900 mg IV every 8 hours PLUS
o Gentamicin loading dose IV or IM (2 mg/kg), followed
by a maintenance dose (1.5 mg/kg) every 8 hours.
Single daily dosing (3–5 mg/kg) can be substituted.
• Nursing Care
o Facilitate vaginal drainage (semi-sitting position/
semifowlers)
o Ensure good perineal hygiene
o Infection control measures
o Health education (life style & promiscuity / STD)
o Advice on healthy nutrition & effects of smoking on
immune response
UTERINE PROLAPSE
• Muscle weakness or relaxation may allow your uterus to sag
or come completely out of your body in various stages:
o First degree: The cervix drops into the vagina
o Second degree: The cervix drops to the level just inside
the opening of the vagina
o Third degree: The cervix is outside the vagina
o Fourth degree: The entire uterus is outside the vagina.
This condition is also called procidentia. This is caused
by weakness in all of the supporting muscles.
fcnlxa – St. Luke’s College of Nursing
• Cystocele: A herniation (or bulging) of the upper front
vaginal wall where a part of the bladder bulges into the
vagina. It’s also called a prolapsed bladder. This may lead
to urinary frequency, urgency, retention, and incontinence
(loss of urine).
• Enterocele: The herniation of the upper rear vaginal wall
where a small bowel portion bulges into the vagina.
Standing leads to a pulling sensation and backache that is
relieved when you lie down.
• Rectocele: The herniation of the lower rear vaginal wall
where the rectum bulges into the vagina. This makes bowel
movements difficult, to the point that you may need to
push on the inside of your vagina to empty your bowel
• Vaginal fistula is an abnormal opening that connects your
vagina to another organ, such as your bladder, colon or
rectum
• Vaginal fistulas can develop as a result of an injury, a
surgery, an infection or radiation treatment
• Vesicovaginal fistula. Also called a bladder fistula, this
opening occurs between your vagina and urinary bladder
and is the type that doctors see most often.
• Ureterovaginal fistula. This type of fistula happens when the
abnormal opening develops between your vagina and the
ducts that carry urine from your kidneys to your bladder
(ureters).
• Urethrovaginal fistula. In this type of fistula, also called a
urethral fistula, the opening occurs between your vagina
and the tube that carries urine out of your body (urethra).
• Rectovaginal fistula. In this type of fistula, the opening is
between your vagina and the lower portion of your large
intestine (rectum)
• Colovaginal fistula. With a colovaginal fistula, the opening
occurs between the vagina and colon.
• Enterovaginal fistula. In this type of fistula, the opening is
between the small intestine and the vagina.
• Signs and Symptoms
o Passage of urine gas, stool or pus from your vagina
o Foul-smelling vaginal discharge
o Recurrent vaginal or urinary tract infections
o Irritation or pain in the vulva, vagina and the area
between your vagina and anus (perineum)
o Pain during sexual intercourse
• Conservative therapy
o Allow your fistula to heal on its own
o Constant bladder drainage using a urinary catheter
o Change your diet and use fibber
• Surgery
o Minimally invasive surgery (laparoscopic surgery)
o Robotic surgery. The location of your fistula determines
whether your surgeon can perform the procedure
through your vagina or your abdomen.
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