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THE NURSE’S ROLE- Is secure about own sexuality- Develops an awareness of feelings, values and attitudes about sexuality- Has knowledge about the structure and function of female and male reproductive systems- Has an accurate and up to date infoTAKE A SEXUAL HISTORY- Explain purpose of interview- Use direct eye contact unless it is culturally unacceptable- Ask open-ended questions- Clarify terminology: use lay terms- Proceed from easier to more difficult topics- Be alert to body language- Listen and react in a nonjudgemental manner- use teachable moments to educate- Do not assume the woman is heterosexual- Be respectfulMENARCHE-Onset of menstruation- Occurs b/w the ages of 8-16 (average age 12.5)- Cycle length 28-32- Amount of flow- moderate- Length of menses- 5 days- Variations are normalEDUCATIONAL TOPICS ABOUT SELF-CARE-Pads and tampons - Tampons should only be worn during day (toxic shock)-Vaginal sprays - sprays can cause irritation, douching can cause Infection, changes pH- Cleansing the perineumASSOCIATED MENSTRUAL CONDITIONSAMENORRHEA-Absence of menses- Primary: menstruation has not been established by 16 years of age- Secondary: when an established menses (of longer than 3 months) ceases *Pregnancy is the #1 cause of secondaryCAUSES- Hypothalamic dysfunction- Pituitary dysfunction- Chronic anovulation or ovarian failure- Anatomic abnormalitiesDYSMENORRHEA-PAINFUL MENSTRATION- Occurs at onset of menstruation- Disappears by the end of menses-PRIMARY: - Cramps w/o underlying disease - CAUSED by - increased production of prostaglandins - Ischemia -TREATMENT - Primary: Oral contraceptives (inhibit ovulation) - NSAIDS (motrin) - Self care measures- heating pads, dec. caffeine et Chocolate, exercise - Regular exercise and rest - Good nutrition -SECONDARY - Occurs after menstruation is established -CAUSED by IUD, ovarian cysts - lasts beyond period - TREATMENT - Continuous oral contraceptive therapy - Hysterectomy if period lasts 3-4 months - Presacral neurectomyPREMENSTRUAL SYNDROME- Experienced by 20-40% of women- Luteal phase of period- affective or somatic symptoms- Occurs after ovulation- Occurs before menses- Occurs in three consecutive menstrual cyclesPREMENSTRUAL DYSPHORIC DISORDERPMDD*A mental disorder- Experienced by 3-8% of women- Marked by 5 or more symptoms- Symptom relief with menstruation- Symptoms during most cycles*Thoughts of suicide*s/s disappear at end of menstruationFAMILY PLANNING AND CONTRACEPTION- Benefits of family planning -Improved health of women - lower rates of induced abortions - fewer unwanted pregnancies and births - improved socioeconomic status*ROLE OF NURSE IS TO EDUCATEFERTILITY AWARENESS-BASED METHODS- Fertility awareness, combined methods: - use of a barrier method during fertile days- Natural family planning - Abstinence during fertile days (PULL OUT METHOD NEVER WORKS)- Basal body temperature method- Ovulation method- Calendar rhythm method- Cervical mucus method- Symptothermal method- Standard days method- Lactational amenorrhea (can still get pregnant)TYPES OF CONVRACEPTIVESSPERMICIDES- Nonoxynl-9 available as - jelly - foam - vaginal film - suppositorySITUATIONAL CONTRACEPTIVES- Abstinence - gaining increased acceptance, but DOES NOT WORK- Coitus interruptus: withdrawl - Oldest least reliable. Feels too good- Douching after intercourse - may actually facilitate conception BARRIER METHODS- Male condom #1 method- Female condom- Diaphragm: must be refitted after birth- Cervical cap- Vaginal Sponge-IUDCOMBINED ORAL CONTRACEPTIVES (COC)- Contain estrogen and progestin- Methods of administration -Day 1 start, Sunday start, Quick startCOC CONTRAINDICATIONS*Previous history of thromboembolic disease - call MD immediately if s/s of DVT- acute or chronic liver disease- presence of estrogen dependent carcinomas- undiagnosed uterine bleeding- heavy smoking- htn, dm- migrane with visual disturbances- hypercoagulable disorders: if on heparin/Coumadin- hyperlipidemiaNONCONTRACEPTIVE BENEFITS OF COC- Relief of menstrual symptoms and premenstrual syndrome- Decreases the incidence of functional ovarian cysts- Reduction in the incidence of: - Ectopic pregnancy and PID - Ovarian, endometrial, and colorectal cancer - Iron deficiency anemia and benign breast diseaseOTHER HORMONAL CONTRACEPTIVES-Combination of estrogen-progestin: - Transdermal - Vaginal Ring - NuvaRing-Progestin only: - Minipill - Long-acting injectable progestin -Depo-ProveraEMERGENCY CONTRACEPTION- Combined oral contraceptive: expensive, must be 18 yrs - May cause N/V - take within 72 hours of unprotected boinking-Progestin-only contraceptive (PLAN-B) - More effective than combined postcoital emergency contraception (EC)-Intrauterine device (IUD) - must be placed within 5 days of unprotected $ex INTRAUTERINE DEVICES- Copper IUD (ParaGARD) - provides protection for 10 years- Mirena Levonorgestrel Intrauterine System -Provides protection for 5 yearsADVANTAGES OF IUD- High rate of effectiveness- Continuous contraceptive protection- Noncoitus-related activity- Relative inexpensiveness over timePOSSIBLE ADVERSE REACTIONS- Increased and intermenstrual bleeding (spotting)- Increased risk for pelvic infection- Perforation of the uterus during insertion- Dysmenorrhea- Expulsion of the device*IUD can lead to infertilitySTERILIZATIONOperative -Vasectomy -Tubal ligation -HysterectomyNon-Operative -EssureSURGICAL PREGNANCY TERMINATIONFIRST TRIMESTER - Safer than 2Nd - Vacuum curettageSECOND TRIMESTER -Dilation and evacuation: dilate cervix and cut what’s thereNURSING MANAGEMENT -Support -EducationMEDICAL PREGNANCY TERMINATION- Milfepristone/misoprostol: -1st 7 weeks of pregnancy- Methotrexate: - 1st 7 weeks of pregnancy -NOT CURRENTLY APPROVED for this useMENOPAUSE-Absence of menstruation for 1 full year- Age of onset (45-55)influenced by: -Overall health -Weight and nutrition -Lifestyle and culture -Genetic factorsMENOPAUSAL CHANGES- Anovulation- Irregular menstruation- amenorrhea- FSH levels rise- Estrogen decreases- Endometrium thins and myometrium, fallopian tubes, and ovaries atrophy- Thinning and dryness of vaginal mucosa; USE KY INTENSE- Vaginal pH increases- Pubic hair thins and turns gray/white (eww)- Labia shrink and lose pigmentation- Pelvic fascia and muscles atrophy- breasts become pendulous- Vasomotor symptoms- Increased in risk for: - HTN - Coronary artery disease: women will experience CP -Stroke-Changes in cognitive functionASSESSMENT OF OSTEOPOROSIS- Bone mineral density testing recommended for - All postmenopausal women aged 65 or older - All postmenopausal women with fractures -Postmenopausal women younger than age 65 with one Or more risk factors: smoking, family hx- HeightPREVENTION OF OSTEOPROSIS- Women over age 50 have a daily calcium intake of 1000mg while on hormone therapy. If not on hormone therapy, 1500mg daily- Vitamin D supplementation- Weight bearing exercise *#1 preventative measure- Consume only modest quantities of alcohol and caffeine- STOP smoking. (ahem)MEDICATION THERAPY- Biphosphonates- Selective estrogen receptor modulators- Salmon calcitonin-Parathyroid hormoneMEDICATION THEARPY CONTINUED- Ultra low does estrogen patchesHORMONE THERAPY- Estrogen therapy- Estrogen-progestin therapy- Administered orally, transdermally, topically- Continuous daily cyclic or sequential therapyWOMEN’S HEALTH PROBLEMSBENIGN BREAST DISORDERS- Fibrocystic breast changes- Fibroadenoma- Galactorrhea- Intraductal papillomas- Duct ectasiaMALIGNANT BREAST DISORDERS- Originates in duct or epithelium of lobes- about 50% originate in upper outer quadrant (axillary)- Common sites of metastasis - Lymph nodes, lungs, liver, brain and boneSYMPTOMS - Dimpling of breast tissue- Recent or acute nipple inversion- Change in breast size or shape- Increase in size of breast mass- Presence of axillary lumpENDOMETRIOSIS- Presence of endometrial tissue outside the uterus*Causes infertility- Most common location is pelvisSYMPTOMS - pelvic pain - dyspareunia - abnormal uterine bleedingTREATMENT - Medical: interruption of cyclic ovarian hormone Production - Surgical: laproscopy, hysterectomy TOXIC SHOCK SYNDROME- Common in reproductive years, postpartum*don’t use tampons unless approved by physicianCAUSED by S.aureus - superabsorbent tampons - diaphragm or cervical cap: must be removed every 24 hoursSYMPTOMS - Fever, rash on trunk, soles of feet and hands, Hypotension, dizziness n/v, decreased loc, comaTSS CONTINUED- Fatal if not treated - Broad-spectrum ABX - Supportive therapyPOLYCYSTIC OVARIAN SYNDROME- SYMPTOMS - menstrual dysfunction - androgen excess - obesity (causes PCOS) - hyperinsulinemia -infertility TREATMENT GOALS - decreasing the effects of hyperandrogenism -Restoring reproductive functioning - Protecting the endometrium - reducing long-term risksRISKS- Type 2 DM- Dyslipidemia- HTN and CV disease- endometrial, breast, and ovarian cancer- Emotional distressABNORMAL UTERINE BLEEDING- Pregnancy- Hormonal d/o- Iatrogenic causes- Mechanical d/o- Infection- CancerDYSFUNCTIONAL UTERINE BLEEDING- Oligomenorrhea- Polymenorrhea- Metrorrhagia- Intermenstrual bleedingMASSESAdnexal mass*Endometrial polyps*Endometrial cancerABNORMAL PELVIC FINDINGSAtrophic vaginitisInfection of the Bartholin’s glandVitiligoLichen sclerosusVulvar bestibulitisCancer of vulva (usually over 60 years old)Cervicitis… DO PAP SMEARS ET COPOSCOPYCERVICAL CANCER*Preventable lengthy preinvasive state- Pap smear: need yearly- Other diagnostics - coposcopy -endocervical curettage- Surgical treatmentHPV- Increased risk for cervical dysplasia (not yet cancerous)and cervical cancer 11 types with an intermediate risk HPV 16 &18 strongly associated- Vaccine available for prevention of 16 & 18SNATCH INFECTIONSBACTERIAL VAGINOSIS- Overgrowth of normal vaginal flora- Thin watery, white-gray discharge- FISHY FISHY odor. Hahahahahahaha- TREATMENT: FlagylVULVOVAGINAL CANDIDIASIS- Fungal or yeast infection- Thick, white vaginal discharge… like cottage cheese- Severe itching, dysuria, and dyspareunia- TREATMENT: Miconazole creamTRICHOMONIASIS (STD) Bacterial organism: Trichomonas vaginalisTRANSMISSION: SEXual intimacy or bathroomAsymptomatic or mild SYMPTOMS: - Yellow-green, frothy, odorous discharge - Vulvar itching - Strawberry like cervixTREATMENT - Must treat both partners - No sex or alcohol during treatment (inhibits effect Of Flagyl)CHLAMYDIA- Most common in US, highest in 15-19 yrBacterial organism: Chlamydia trachomatisTRANSMISSION: vaginal SEXSYMPTOMS: 70% of women are asymptomaticMucopurulent dischargeTREATMENT - Azithromycin or doxycyclineGONORRHEABacterial organism: Neisseria gonrrhoeae - oldest STD- very severe - rapidly becoming resistant to cureTRANSMISSION: Vaginal, anal, oral, and nasal sexSYMPTOMS: 70% of women are asymptomatic- usually associated with ChlamydiaTREATMENT - Ceftriaxone (ABX) - left untreated will cause endocarditis, meningitis -may cause newborn blindnessHERPES SIMPLEXLIFELONG VIRAL INFECTION -HSV-1: Blisters on lips, eyes, face -HSV-2: Invades genital tractTRANSMISSION- vaginal, anal, oral, or nasal sex, including kissing - skin-to-skin contact with an infected siteSYMPTOMS: primary outbreak - single or multiple blister like vesicles - difficult urination and urinary retention - enlargement of iguinal lymph nodes - flu like symptoms, genital pruritis, or tinglingTREATMENT-AcyclovirSYPHILIS- Systemic diseaseBacterial organism: Treponema pallidumTRANSMISSION - Vaginal, oral, anal, or nasal sex - Exposure to exudates from infected individual - TransplacentalTREATMENT -PCN G - Disability and death if untreatedSYMPTOMS EARLY STAGE- Chancre appears, fever, weight low, malaiseSYMPTOMS: SECONDARY STAGE- Condylomata lata on vulva- Acute arthritis- Enlargement of liver and spleen, enlarged lymph nodes- Chronic sore throat with hoarsenessGENITAL WARTS- Currently most common in US- Responsible for 95% cervical squamous cell carcinoma-Viral organism: (HPV)- TRANSMISSION: Vaginal, oral, anal sexGENITAL WARTS CONTINUE-SYMPTOMS - Genital warts- may be painful, cauliflower looking -condylomata -pruritisTREATMENT- client or provider therapies for wart removal 100% curePENDICULOSIS PUBIS- Parasite: PhthirusTRANSMISSION: Intimate sexual contact, shared towels and bed linensSYMPTOMS - itching in pubic areaTREATMENT - 1% permethrin crea; wash and dry linens, towels, and clothingINFLAMMATORY DISEASE (PID)-Inflammation of upper female genital tract-Chlamydia and gonorrhea- Post infection tubal damage associates with infertilityDIAGNOSIS -endometrial biopsy - vaginal ultrasound - exploratory laparoscopyTREATMENT - IV fluids - pain meds - IV abxSYMPTOMS OF PID- Bilateral sharp, cramping pain in lower quadrants- fever greater than 101, chills- mucopurulent cervical or vaginal discharge- irregular bleeding- cervical motion tenderness during intercourse- malaise, nausea, and vomitingCYSTITSCaused by pressure on bladderRISK FACTORS- sexual intercourse- use of a diaphragm and a spermicide- delayed postcoital micturition- pregnancy- hx of a recent UTI*severe does not go away*many women can’t get rid of it. Considered a disabilitySYMPTOMS- Dysuria, urgency, and frequency- suprapubic or low back pain- low grade fever- hematuriaTREATMENT -ABX therapyPYELONEPHRITIS:SYMPTOMS- sudden onset with chills, high temp, and costovertebral angle tenderness or flank pain- nausea, vomiting and malaise-frequency, urgency, and burning with urination-decreased urinary output- severe colicky pain, vomiting, dehydration, and ileus of the large bowelHEALTH TEACHING- Planning ahead and developing strategies to say no to sex… (uh huh)- Limiting the number of sexual contacts and practicing monogamy - Using a condom (such as Trojan ecstacy) and negotiating condom use with a partner - A checklist with what type/flavor/size of condom along with a liability waiver (should the condom be defective and conception accidentally take place) should be signed before any sexual contact happens to ensure both parties are aware of the risks.- Reducing high-risk behaviors such as use of alcohol and recreational drugs ................
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