TRANNIES

N-109 MCN 2 LEC | Care of Mother and Child at Risks or with Problems (Acute and Chronic) Lec

REPRODUCTIVE HEALTH PROBLEMS

Mrs. Geraldine Rowena S. Galang-Gatbonton, MAN, RN
Topic 3 : Week 10

○ It can also be because of hormonal imbalances,

OUTLINE presence of ovarian tumor, yung may mga
A. Infertility radioactive substances.
B. Sexually Transmitted Diseases ○ It could also be because of general ill health, poor
1. Genital Herpes diet, or even stress.
2. Chlamydia 2. Tubal transport, uterine, cervical, vaginal problems
3. Gonorrhea ○ Nagkaroon ng scarring, or infection before.
4. Syphilis ○ Pelvic inflammatory disease.
C. Menstrual Disorders ○ Matagal na IUD.
D. Female Neoplasia ○ Tumor
1. Fibrocystic Breast Disease ○ Endometriosis
2. Breast Cancer ○ Other infections
3. Myoma
4. Uterine Cancer ● Other Reasons Why You’re Not Getting Pregnant:
5. Polycystic Ovary Syndrome 1. Not ovulating
6. Ovarian Cancer 2. Male infertility
7. Cervical Cancer 3. Age
E. Male Neoplasia 4. Blocked fallopian tubes
1. Benign Prostatic Hyperplasia 5. Endometriosis
2. Prostate Cancer 6. Underlying medical problems

INFERTILITY
● Inability to conceive a child or sustain pregnancy to birth after
at least a year of unprotected sexual intercourse.
○ If hindi pa umaabot ng 1 year ang unprotected sex ang
isang couple, hindi pa agad dina-diagnose as infertility.
○ Most couples have the potential to conceive but they
are less able to do this without additional help, yung
term na subfertility is more often used today.
● On the other hand, sterility is the inability to conceive
because of a known condition.
● Female infertility:
○ Inability to conceive or deliver a live infant after 3
consecutive pregnancies.
● Male infertility:
○ Inability to impregnate a woman under the same
conditions.
KINDS OF INFERTILITY
1. Primary Infertility
● Never been pregnant or never impregnated.
2. Secondary Infertility
● Pregnant once, then unable to conceive again.
FERTILITY TESTING
● Semen Analysis
● Sperm Penetration Assay and Antisperm Antibody Testing
● Ovulation Monitoring
● Ovulation Determination by Test Strip
● Tubal Patency
○ How patent reproductive organs are such as fallopian
tubes and uterus.
● Uterine Endometrial Biopsy
● Hysteroscopy
○ A surgical procedure to remove the womb (uterus).
○ Women can no longer be pregnant after this procedure.
● Laparoscopy
○ A surgical diagnostic procedure to examine the organs
inside of the abdomen, without making large incisions.
NOTE: In a small number of couples, no known cause for subfertility
can be discovered. Possible problems are either partner alone are
not significant but when combined it is sufficient enough to create
subfertility among the couples.
○ This is very discouraging, but we can offer to continue to
conceive through assisted reproductive techniques or through
adoption, or have a child-free life.

NOTE: ASSISTED REPRODUCTIVE TECHNIQUES

● Remember that when engaging in coitus(sex), at least 4x a 1. Therapeutic Insemination
week.
○ 50% of the couples will conceive within 6 months.
○ 85% of the couples within 12 months.
● However, couples who engage in coitus everyday may
actually have more difficulty conceiving than those who are
spaced for every other day. This is because of lower sperm
count per ejaculation.

SUBFERTILITY FACTORS
● Male Subfertility Factors:
1. Inadequate sperm count
○ Normally, dapat 20 million sperm per ml of semen
or 50 million per ejaculation.
○ Dapat at least 50% are motile and 30% normal in A. Sperm is deposited next to the cervix
shape and form. B. Injected directly into the uterine cavity
2. Ejaculation problems ● Here, wala yung natural sexual intercourse, but i-inject via
○ It could be because of psychological or chronic vagina ang donor’s sperm, it could be from the sperm of the
disorders such as CVA, Hand stroke, DM, male couple or another male’s sperm.
Parkinson’s disease, or side effects of having ● Natural fertilization, natural implantation, and the rest will
some medications. follow.
○ Also, erectile dysfunction or the impotence
inability to achieve erection can be a factor. 2. In Vitro Fertilization
■ A drug called sildenafil or viagra can
help achieve erection.
○ May premature ejaculation in which ejaculation
occurs before penetration, it may be common
among adolescents but it will improve until the
male is more experienced.

● Female Subfertility Factors:

1. Anovulation
○ The absence of ovulation.
○ It may be because of Turner syndrome. A
congenital/ chromosomal abnormality.

MCN 2 Lec – Reproductive Health Problems 1

 A. Ovulation
B. Capture of ova (intra- abdominally)
C. Fertilization of ova and growth in culture medium
D. Insertion of fertilized ova into uterus

● Walang sexual intercourse and hindi rin natural ang

fertilization.
● Here, sa test tube nag fefertilize ang egg and sperm.
○ It could be the egg and sperm of the couple or a donor.
● Kapag nabuo na, tyaka na iimplant sa uterus, pwede sa
uterus mismo ng nanay or magkakaroon ng surrogate
mother.
● Still a natural implantation process.

ALTERNATIVES TO CHILDBIRTH
1. Surrogate mothers 2. CHLAMYDIA
○ Kapag nabuo na, tyaka na iimplant sa uterus, pwede sa
uterus mismo ng nanay or magkakaroon ng surrogate
mother.
○ This is still a natural implantation process.
2. Adoption
○ Most extensive child legal process.
3. Child- free living

MANAGEMENT
1. Increasing sperm count and motility.
● Abstain coitus 7 to 10 days.
● Ligation varicocele, if present. Impedes with effectivity
of sperm
○ Varicocele: enlargement of the veins within the
loose bag of skin that holds the testicles.
○ Standard procedure to remove swollen veins
around the testicles and helps restore a balanced
blood flow to male reproductive organs.
● Change in lifestyle.
○ Kung may mga vices, most specially.
2. Reducing the presence of infection.
● Treat reproductive infections based on culture reports.
○ Whether female or male, ibase sa cultural report
para malaman paano madedestroy yung mga
causative agents.
● Currently the most common STD.
● Here, there are no vesicles but there are symptoms that
include heavy and purulent vaginal discharge, or may be
asymptomatic at times.
● Can be transmitted to the fetus at birth, causing neonatal
ophthalmia.
● Intervention: Treated with erythromycin, prophylactic
treatment of neonate’s eyes.
● If untreated, this can lead to pelvic inflammatory disease
(PID).
3. GONORRHEA

3. Hormone therapy.
● GnRH or clomiphene citrate (Clomid) to stimulate
ovulation
● Conjugated estrogen for scant, tenacious vaginal
secretions which impedes with effective fertilization
● Progesterone vaginal suppositories for luteal phase
defect.
● Caused by Neisseria Gonorrhea.
4. Surgery ● Similar to Chlamydia, symptoms include heavy and purulent
● Ligated tubes can be reopened. vaginal discharge but often asymptomatic in females.
● Removal of uterine tumors, if present. ● Can be transmitted to fetus at birth, causes neonatal
ophthalmia and sepsis as well.
● Treatment is penicillin, allergic clients may be treated with
erythromycin or cephalosporins.
SEXUALLY TRANSMITTED DISEASES
● It is important that all sexual contacts must be treated as well.
1. HERPES
4. SYPHILIS

● Caused by Herpes Simplex Virus Type 2 (HSV2)

● Causes:
○ Painful vesicles on genitalia (external and internal)
○ Kapag sinabing vesicles meron siyang laman na liquid
sa loob.
● NO CURE! since viral siya.
● Treatment is SYMPTOMATIC. ● Caused by Treponema Pallidum (spirochete).
● Acyclovir reduces severity and duration of exacerbation. ● This is somehow dangerous for the fetus because it crosses
● NOTE: If active infection at the end of pregnancy, CS birth the placenta after the 16th week of pregnancy.
may be indicated, since the virus may be lethal to neonate. ● Diagnosis is made by dark-field exam and serologic tests
● Recurrences of the condition may be caused by infection, (VDRL – Venereal Disease Research Laboratory test)
stress, and menses. ● Treatment is PENICILLIN or ERYTHROMYCIN.
● In the photo you can see that the mother’s genitalia has ● In the photo, you can see the three (3) or triad symptoms ng
active herpes because of vesicles. However, nung nalipat sa syphilis.
baby, nagkaroon ng blisters all over the body, especially in
the trunk area.
MCN 2 Lec – Reproductive Health Problems 2
 SYMPTOMS
1. Initial symptoms are chancre and lymphadenopathy and
may disappear without treatment in 4 to 6 weeks.
● Chancre is an open sore sa genitalia or may sugat sa
genitalia as well as lymphadenopathy. The bad thing is,
kahit wala kang gawin dito, the initial symptoms may
disappear without treatment in 4 to 6 weeks. Yun pala,
nagp-progress na yung infection. Paglabas ng
secondary symptoms
2. Secondary symptoms are rash, malaise, and alopecia, and
these too may disappear in several weeks without treatment.
3. Tertiary symptoms of syphilis may recur later in life and
affect any organ system, especially heart and brain.
● Pag lumabas ang tertiary symptoms, delikado siya

C. MENSTRUAL DISORDERS
1. Dysmenorrhea ➜ painful menstruation
2. Mittelschmerz ➜ painful ovulation
3. Amenorrhea ➜ cessation of menstruation (ang normal na
meron ito ay yung mga buntis at menopause)
4. Menorrhagia ➜ heavy menstruation ● https://rb.gy/jqmzno
5. Metrorrhagia ➜ bleeding in between periods ● It is also important to do a monthly self-breast exam.
6. Menometrorrhagia ➜ may mga babaeng malakas na mag Importante ang self-breast exam as a screening test to
mens tapos madalas pa mag mens actually detect an early stage most especially if it is a breast
cancer.
NOTE: Post-menopausal clients usually experience vaginal dryness ○ When to perform a self-breast examination? BEST is 1
and even dyspareunia. This is because of estrogen deficiency. week or 7-10 after the first day of menstrual flow. By
Nagkakaroon sila ng painful sex, we can teach them to use that time, menstruation is done, hindi na congested ang
water-soluble lubricants for intercourse. katawan ng babae.
● Annual breast ultrasound is also important. Lalo na yung
may mga high risk of having breast cancer if you have a
family member or parent with breast cancer.
D. FEMALE NEOPLASIA
○ Mammography is an x-ray, contraindicated if the
1. Fibrocystic Breast Disease: benign breast tumor patient is pregnant. Baseline mammography is
2. Breast Cancer: malignant breast tumor important at 35 years old.
3. Myoma: benign uterine tumor ■ When you are teaching clients who will undergo
4. Uterine Cancer: malignant uterine tumor mammography, teach them to avoid cream,
5. Polycystic Ovary Syndrome: benign ovary tumor powder, deodorant on the breast or underarm
6. Ovarian Cancer: malignant ovary tumor because these substances can be shown on the
7. Cervical Cancer x-ray.
■ Mammography is very uncomfortable. There is
discomfort because the breast are compressed
1. FIBROCYSTIC BREAST DISEASE pero mabilis lang naman ang procedure, in less
than an hour, yung test matatapos na.

2. BREAST CANCER
● Most common neoplasm in women.
● In fact, it is the leading cause of death in women ages 40 to
44 years.

ASSESSMENT
1. Palpation of lump, usually
upper outer quadrant.
● Kaya pag mag-bbreast
self-exam, do not
● Round, fluid-filled cysts form in breast tissue forget to include
● Most common benign breast lesion. palpating or checking
● May be caused by Helicobacter Pylori transmitted during the upper outer
sexual foreplay. quadrant of the breast
● It can occur as early as puberty pero common din siya sa late including the axilla
adolescence hanggang 45 years old. 2. Skin of breast dimpled.
3. Nipple discharge.
SYMPTOMS ● Which is not breast milk for breastfeeding women
1. Freely movable, well-delineated breast lumps that feels 4. Obvious asymmetry of breasts.
painful, tender, stretched. Lalo na pag kinapa ● Among women, it is normal that the breasts are
2. May be visible on the surface of the breast, usually palpated asymmetrical. But here there is really an obvious
in the upper outer quadrant. asymmetry.
3. Consistency may be firm and hard but sometimes they are 5. Surgical biopsy provides definitive diagnosis
soft and flexible. ● Mayroon ding mga tumor markers:
4. May shrink or disappear during pregnancy or lactation, and a. glycoprotein CA 125,
totally disappear with menopause. b. glycoprotein CA 15-3
c. carcinoembryonic antigen or CEA.
MANAGEMENT
THE STAGES OF BREAST CANCER
1. Provide simple analgesic, do warm compress, avoid trauma,
and wear firm bra support to relieve discomfort. ● Mga babae na may higher risk of developing breast cancer:
2. Avoid coffee, cola, tea, chocolates, to lower risk of cystic ○ mga nulligravida,
formation ○ yung may mga history mismo ng breast cancer ang
3. Lower Na intake or short term use of diuretic just before parent or immediate relative
menses to reduce fluid retention. ○ yung usual exposure sa mga carcinogens
4. Cystic aspiration to reduce size of cyst and provide fluid for
biopsy. STAGES OF BREAST CANCER
5. Danazol (Danocrine) to suppress estrogen formation in O. Abnormal cells are present but have not spread to
ovaries and reduce symptoms. nearby tissue
6. Surgical removal of cysts. I. Early Stage Cancer has spread to other tissue in small area
II. Localized Tumor is between 20-50 mm and some lymph
nodes are involved or a tumor larger than 50
mm with no lymph nodes involved.
MCN 2 Lec – Reproductive Health Problems 3
III. Regional Tumor is larger than 50 mm with more lymph 3. Tiredness, weakness, or lethargy
Spread nodes involved across a wider region. In some 4. Urinary frequency or retention – as the myoma enlarges
cases, there is no tumor present at all, Cancer 5. Abdominal pain na localized
may have spread to skin or chest wall. 6. Dyspareunia
IV. Distant Cancer has spread beyond the breast to other 7. Foul or watery vaginal discharge
Spread parts of the body. 8. Infertility

● Staging refers to how far cancer has spread. MEDICAL MANAGEMENT

● Grading refers to how abnormal the cells appear When a woman has myoma, as long
as wala siyang nararamdaman na
MANAGEMENT manifestations, hindi naman agad
1. Surgical Excision siya nirerequire iremove
● Simple lumpectomy ➜ removal of the lump only
● Simple mastectomy ➜ removal of the breast 1. Myomectomy – removal of
● Modified radical mastectomy (MRM) ➜ removal of myoma; but even if you
entire breast tissue; surrounding tissues pero may remove myoma because it is
tinitira usually na magagamit especially for those a tumor that proliferated from
women na gusto magkaroon ng breast augmentation or the myometrium, maaari
artificial in the future; usual surgical procedure used for siyang umulit.
breast cancer ● In this case, maaaring
● Radical mastectomy ➜ removal of everything; irecommend na iremove
including all the tissues and the surrounding tissues of ang uterus. But, it is only recommended for those
the breasts women na may mga anak na o matanda na.
2. Subtotal hysterectomy – just a portion of the uterus (esp
2. Adjuvant treatment ➜ used in combination with the surgery the area where myoma has proliferated)
which is for all types of breast cancer 3. Total hysterectomy – entire uterus
● Chemotherapy ➜ use of very strong chemical to kill 4. Total abdominal hysterectomy and bilateral
cancer cells salpingo-oophorectomy
● Hormonal therapy
● Radiation
4. UTERINE CANCER
TUMOR SIZE CHART ● A cancer that arises from the endometrium as a result of the
abnormal growth of cells that have the ability to invade or
spread to other parts of the body.
● If diagnosed early, ang UC ay may favorable outcome.
● Occurs most commonly after menopause
● Ang kaniyang overall 5-years survival rate is actually more
than 80%.
● Diagnosed by endometrial biopsy through D&C
● Nadedetect din ito through pelvic exam especially after
menopause.
● NOTE: Remember that pap smear is not useful sa UC
detection. It is only for cervical cancer detection.

3. MYOMA
● Benign tumors, uterine
fibroids, or leiomyomas of the
uterine muscles.
● Originated from the
myometrium
● Begin as a simple
proliferation of smooth
muscle cells and increased
growth is stimulated by stress
within the myometrium
● Classifications: ● In the photo, we can see
○ Intramural – within D&C to get endometrial
uterine wall samples or tissues for
○ Submucosal – under checking whether the
the endometrium tissues there are regarded
○ Subserosal – outer surface of the uterus as benign or malignant
○ Wandering or Parasitic – attaches to tissues other
than the uterus
○ Intraligamentary – within pelvic ligaments
○ Cervical – within the cervix

MANIFESTATIONS

MANIFESTATIONS
1. Vaginal bleeding or spotting after menopause
2. Long, heavy, or frequent episodes of bleeding in women
before menopause
● If you look at the manifestations, most of them are about
bleeding because symptoms other than bleeding are not
common in uterine cancer. But those include white clear
vaginal discharge in menopause, enlarged uterus, lower
abdominal pain, dyspareunia, painful urination, or pyometra
or uterine infection.
● Risk factors include obesity, DM, breast cancer, tamoxifen
1. Abnormal excessive uterine bleeding use (chemotherapy drug), nulligravid, late menopause,
2. Anemia increasing age, and high levels of estrogen
MCN 2 Lec – Reproductive Health Problems 4
These are the staging and grading of uterine cancer depending on SIGNS AND SYMPTOMS
how invasion occurs and how the cancer looks like. 1. Menstrual disorders
● Oligomenorrhea halos di nagmmens
STAGE I* Tumour confined to the corpus uteri ● Amenorrhea
IA* No or less than half myometrial invasion 2. Infertility
IB* Invasion equal to or more than half of the ● Chronic anovulation due to the presence of many
myometrium cysts
STAGE II* Tumour invades cervical stroma, but does not 3. Hyperandrogenism increased androgen activity
extend beyond uterus** ● Acne
STAGE III* Local and/or regional spread of the tumour ● Hirsutism
IIIA* Tumour invades the serosa of the corpus uteri ● Menometrorrhagia
and/or adnexa*** ● Androgenic alopecia
4. Metabolic Syndrome
IIIB* Vaginal and/or parametrial involvement***
● Obesity
● Insulin resistance
IIIC* Metastases to pelvic and/or para-aortic lymph
nodes***
IIIC1* Positive pelvic nodes
IIIC2* Positive para-aortic lymph nodes with or without
positive pelvic lymph nodes
STAGE IV* Tumour invades bladder and/or bowel mucosa,
and/or distant metastases
IVA* Tumour invades bladder and/ or bowel mucosa
IVB* Distant metastasis, including intra-abdominal
metastases and/or inguinal lymph nodes

MANAGEMENT
1. Surgery
● TAHBSO – total
removal
● Lymphadenectomy
– surgical removal of
one or more groups
of lymph nodes;
almost always
performed as part of MANAGEMENT
surgical treatment ng 1. Diet to lose weight. Most effective to restore normal ovulation
maraming classes and mens. Kailangan significant part of carbohydrates would
ng cancer. come from fruits, vegetables and whole grain sources
● Cytoreductive 2. Medicating with
surgery – used to a. Oral contraceptives – binds w/ testosterone reducing
remove tumors; hirsutism and regulating the mens
cytoreduction— b. Metformin – oral hypoglycemic drug; treats insulin
reducing the number of tumor cells and considerably resistance and supports ovulation
increases life expectancy and nagrereduce ng rate ng 3. Clomiphene citrate for infertility to promote ovulation.
mga cancer recurrence. Although not all are infertile
4. Standard contraceptive pill, spironolactone as
2. Adjuvant Therapy anti-androgens for hirsutism and acne. Yung progesterone, it
● Chemotherapy should be avoided because of its androgenic effects
○ Drugs used are paclitaxel, doxorubicin, 5. Regulate menstruation with pills. This can be given is fertility
cisplatin, carboplatin is not the aim
○ These are used when surgery is not indicated.
Pwede rin siya for palliative and longer survival.
● Hormonal therapy – like medroxyprogesterone 6. OVARIAN CANCER
acetate (tumor suppressor) ● Occurs when abnormal cells in the ovary begin to multiply out
● Radiotherapy of control and form a tumor.
○ Vaginal brachytherapy – invasive siya;
naka-implant yung radioactive substance so that OTHER SYMPTOMS
woman is also radioactive kaya ang woman ay Symptoms can be overlooked kasi maraming symptoms yung maari
naka-confine sa hospital mo rin makita sa ibang disease conditions.
○ External beam radiotherapy – outpatient; the 1. Unexpected vaginal bleeding.
radioactive substance is exposed; para siyang 2. Constipation
machine na naka-direct kung saan yung cancer 3. Nausea, Indigestion, Appetite Loss
cells na minamanage; only effective for stage 1 4. Weight loss
and stage 2 cancer. 5. Breathlessness, fatigue

#KnowOvarian, signs & symptoms from ovarian.org picture

5. POLYCYSTIC OVARY SYNDROME 1. Feeling the need to urinate urgently or often
2. Trouble eating or feeling full quickly
3. Pelvic or abdominal pain
4. Bloating

RISK FACTORS
1. Family history of ovarian and breast cancer
● Usually close relative
● With breast cancer, some opt to remove ovary as well
as the form of prevention.
2. Age over 63 years
● 50% of cases of ovarian cancer are beyond this age.
3. Children after age 35 or never having children
● Breastfeeding and use of contraceptive pills lower the
risk of having ovarian cancer.
● A set of symptoms due to elevated androgens in females.
4. Undergoing hormone replacement therapy after
● Most common endocrine disorder in females ages 18 to 44.
menopause
● Diagnostic Criteria:
● Remember that longer the usage, the higher the risk.
○ Oligoovulation or anovulation
5. Obesity and overweight
○ Excess androgen activity
● Usually common with those with a BMI over 30.
○ Polycystic ovaries

MCN 2 Lec – Reproductive Health Problems 5

6. High levels of androgen, diet, and use of talcum powder.
● Although researchers have not yet proven the link,
these risk factors increase the risk of having ovarian
cancer.

STAGE AND GRADE

● Localized
○ Affect only the ovaries or fallopian tubes.
● Regional
○ Has spread to nearby organs, such as the uterus.
● Distant
○ Present elsewhere in the body such as the lungs or
liver.

● Pap smear is taken for early detection and diagnosis of

precancerous and cancerous conditions of the cervix, vulva,
or vagina.
○ In the photo, you can see how to obtain a traditional
pap smear using a vaginal speculum.
○ The specimen is collected from the endocervix, the
cervix, and the vaginal area.
■ These will be tested under laboratory conditions
for the presence of abnormal cells.
■ It can also reveal inflammatory and infectious
TYPES OF OVARIAN CANCER diseases.
1. Epithelial Cells ○ When to have pap smear?
● Occur in the lining of the surface of the ovary. ■ According to the American Cancer Society, 21
2. Germ Cells years old or 3 years after being sexually active.
● Which will become eggs for reproduction. ■ Kung after 30, every 2-3 years.
3. Stromal Cells ■ If you are high risk, kailangan more frequent ang
● Which releases hormones and links up the structures of pag perform ng pap smear.
the ovaries.
TABLE 11.3: Interpretation of Pap Smears (CIN and Bethesda
DIAGNOSIS Systems)
1. Pelvic examination, transvaginal ultrasound No. Dysplasia CIN: Cervical Bethesda System
● Ito ay ang mga soundwave na nag-dedetect ng tumor Intraepithelial
but this cannot actually determine if it is cancerous. Neoplasia
2. Blood test to measure cancer antigen 125 (CA-125) 1 Benign Benign Normal
● A biomarker specific for ovarian cancer. However, it can 2 Benign with Benign with Normal but with
also be affected with uterine cancer inflammation inflammation atypical squamous
3. Biopsy cells of
undetermined
TREATMENT significance
1. Surgery (ASC-US)
2. Chemotherapy 3 Mild dysplasia CIN I Low-grade
3. Radiation squamous
intraepithelial lesion
STAGE Invasive Ovarian Germ cell (LSIL)
epithelial stromal tumors tumors of the 3a Low-grade CIN II
ovarian cancer ovary squamous
Localized 92% 99% 98% intraepithelial
Regional 75% 89% 95% lesion
Distant 30% 61% 75% 3b Severe dysplasia
4 Carcinoma in situ CIN III High-grade
squamous
7. CERVICAL CANCER intraepithelial lesion
(HSIL).
5 Invasive cancer Invasive cancer Invasive cancer

● Colposcopy
● Cancer that occurs in the cells of the cervix.
● Most cases are linked to infections caused by the human
papillomavirus (HPV).
○ Remember that the cervical cancer cells grows slowly,
○ So, when detected early, there is time to find and treat
before serious problems occur.
○ Improves screening by the use of a pap test or pap
smear.
■ Ages 35-44 are most likely to get it, but also in
women over 65 especially those who don’t do
regular screening.
○ Another way to determine cervical cancer through
visualization of the cervix.
○ Maari din gawin dito ang cervical biopsy as a definitive
diagnosis.
○ Nursing interventions after the treatment or test
1. Keep the perennial clean and dry
2. Change pads frequently
3. Teach women to not lift heavy objects
4. No intercourse in 2 weeks to prevent bleeding
5. Kailangan mag-report si patient kung nagkaroon
man’ siya ng excessive bleeding.

MCN 2 Lec – Reproductive Health Problems 6

 RISK FACTORS
1. Started having sex before 16 or
within a year of menarche.
2. Multiple sexual partners.
3. Contraceptive use, usually
longer than 5 years.
4. Smoking
5. Weak immune system.
6. Presence of an STD.

● Prevention
○ HPV vaccine
■ Gardasil, in the form of gardasil or other brand is
given as an IM injection of 3 doses
○ Cervical screening is important through pap smear
MANIFESTATIONS
SYMPTOMS 1. Urinary frequency
1. Dyspareunia, painful sexual intercourse 2. Trouble starting to urinate
2. Unusual vaginal bleeding or discharge 3. Weak and dribbling urination
3. Pelvic pain 4. Inability to urinate
4. Loss of appetite and weight loss 5. Loss of bladder control
5. Fatigue, General body weakness 6. Blood in urine late stage

MEDICATIONS
1. Alpha Blockers
● Doxazosin
● Tamsulosin
➜ These relax smooth
muscles in the
prostate and
bladder neck.
Therefore, nag
dedecrease yung
blockage ng urine
flow at nakakaihi
nang maayos

2. 5a-Reductase Inhibitors
MANAGEMENT ● Finasteride
● Precancerous Lesions can be managed through ● Dutasteride
1. Cryosurgery – Freezing ➜ They inhibit the hormone responsible for prostate
2. Diathermy – Cauterization/ Burning enlargement. These drug helps the male achieve better
3. Laser surgery – Laser Beam Vapor urination
4. Hysterectomy – You already keep the woman from
getting cancer ● Diagnosis is made through symptoms after ruling out other
➜ All of this would little damage to nearby tissue possible conditions
● Cervical Cancer
5. Surgery TRANSURETHRAL RESECTION OF THE PROSTATE
6. Chemotherapy (TURP)
7. Radiation therapy ● A urological operation used to treat BPH.
● It is performed by visualizing the prostate through the urethra
and removing tissue by electrocautery or sharp dissection.
● This procedure is done with the use of spinal or general
anesthetic.
○ Kasi masakit siya dahil may tubo na ipinapasok directly
in the urethra of the male
● A large triple lumen catheter is inserted through the urethra to
irrigate and drain the bladder after the surgical procedure is
complete.
○ After the procedure, ang mga nurses dapat
minomonitor ang continuous bladder irrigation. It
remove clots from the bladder and it prevents
obstruction of the catheter
● Outcome is considered excellent for 80% to 90% of BPH
patients.
○ Tinuturo natin ang self catheterization. It’s usually done
intermittently, this will relieve urinary retention although
UTI is common

E. MALE NEOPLASIA

1. BENIGN PROSTATIC HYPERPLASIA (BPH)

● A prostate enlargement characterized by non-cancerous
increase in its size.
● Benign tumor in prostate
● Prostate is pressing in the urethra that is the reason why it
makes it difficult to urinate
● May complications dahil affected ang urination
○ Can cause UTI, bladder stones or Chronic Kidney
problem
● The cause of BPH is unclear.
● Typically begins after age 40 years old and half of males over
age 50 and above are affected
● Tumataas ang PSA (Prostate Specific Antigen) although it
does not increase the risk of prostate cancer

MCN 2 Lec – Reproductive Health Problems 7

 2. PROSTATE CANCER 2. Surgery through prostatectomy
● Cancer that occurs in ● It can be performed through the laparoscopy or
the prostate gland. open surgery
● Usually grows slowly 3. Radiation through brachytherapy or external beam.
and may not cause ● [Internal] Sa Brachytherapy may implant
serious harm right away. ● [External] Yung external beam mayroong mga
● Malignant intensity modulated beams radiated to elicit
● When detected early radiation towards the prostate gland
and still confined to the
prostate gland, there is ● Advanced Stages or Systemic
a better chance of ○ Surgery may not helpful anymore
successful treatment 1. Chemotherapy
● According to American 2. Hormonal therapy
Cancer Society (2019), 3. Immunotherapy
around 1 in 9 males will
be diagnosed with prostate cancer, however only 1 in 41 will
die because of it

RISK FACTORS
1. Age over 55 – Elderly are more at risk
2. African-American race – usually black men
3. Family history – of having prostate, and breast cancer
4. Smoking men linked to higher risk of dying
5. Obesity – doubles the risk

● FACE up to Prostate Cancer (picture)

○ Family history
○ Age
○ Changes in your pee
○ Ethnicity

SCREENING TESTS
1. Prostate Specific Antigen (PSA)
● Can be used to detect prostate
cancer early
● Protein made only by the prostate
○ Low it is healthy
○ High it may indicate cancer
○ Pwede ring mag indicate ng
BPH, infection or inflammation
of the prostate

2. Digital Rectal Examination (DRE)

● If you palpate there is a feeling of an
abnormal shape or thickness to the
prostate
● Younger is recommended to take the
exam if the male is considered high risk

● Recommendation of American Cancer Society is yearly PSA

and Digital Rectal Exam at 50 yrs. old, specially if we want
early detection

CONFIRMATORY TEST
● Tissue Biopsy
○ Kayang gawin through DRE

SYMPTOMS
● Prostate Cancer has no signs and symptoms in its early
stages, but as the prostate enlarges the usual manifestations
would include different urination problems
1. Weak or interrupted (*stop-and-qo") of urine.
2. Sudden urge to frequent urination
3. Trouble starting urine/ emptying bladder completely.
4. Painful/ burning urination
5. Blood in the urine or semen.
6. Pain in the back, hips, or pelvis late signs
7. Breathlessness/ tiredness/ dizziness/anemia late signs

TREATMENT
● Early Stages
1. Monitoring PSA
● With early stages there is no immediate action, as
the risk may outweigh the benefit

MCN 2 Lec – Reproductive Health Problems 8