Women's preventative health & HPV

• Leading cause of death in females is heart disease
• Heart attack & Stroke Warning Signs include fullness or pain in the center of chest
• Actions for reducing risk include:
  • Getting at least 150 min of moderate-intensity physical activity per week
  • Eating dairy, fruits & veggies
  • Maintain a BMI of 18.5-24.9
  • Avoid being obese (over 30 BMI) or underweight (less than 18.5 BMI)
• Method to promote Health involves receiving recommended immunization for female adults aged 19 & older
• HPV vax: 3 doses for women aged 19-26

HPV (Human Papilloma Virus)

• Gardasil, Gardasil 9 & Cervarix prevent most cervical cancer cases & genital warts
• HPV is the main cause of cervical cancer and genital warts
• HPV is the most common STI virus in the US
• HPV vaccine is most effective if given before the person becomes sexually active
• 2 doses are recommended for person initiating vax before age 15, 2nd dose is given 6-12 months after 1st dose

STIs

• Condoms should be used correctly and for all sexual contact
• MRI screening & mammograms are recommended for women at high risk for breast cancer
• Women should not wear any deodorant, perfume, lotion or powder under their arms on day of appt, as it can make shadows on x-ray
• Cervical cancer screening is recommended at age 21 & older with a cervix
• Prior to a Pap smear, you should not have sex for 48 hrs before test, and avoid douching.

Puberty

• Onset for girls: age 8-13 yo

• Involves growth of body hair: axillary & pubic hair

• Begins 2- 2.5 years before menstruation starts

• Puberty is complete when menstruation assumes a regular pattern.

Menopause

• The stage of life that marks permanent cessation of periods
• Occurs in ages 35-58
• During irregular menstrual cycles, a woman can still become pregnant
• Hot flashes are the most common symptoms of menopause
• Hot flash triggers: spicy foods, caffeine & alcohol, hot beverages
• Fluoxetine (Prozac), Gabapentin (Neurontin) & Clonidine (Catapres) : decreases hot flashes
• Black cohosh tx has no proven benefit and may place women at risk for liver toxicity
• Estrogen alone is prescribed for women with NO uterus
• Hormone Therapy should be 5 years or less combine usage and length should be individualized

Sexual Dysfunction

• Vaginal dryness interventions: use water based lube, vaginal moisturizers, estrogen vaginal cream, soy flour & flax seeds in women diets may prevent or decrease degree of vaginal dryness

Osteoporosis

• Risk factors: Caucasian women, thin small-bones, fam hx of hip fx, current smokers, those who take certain meds like corticosteroids for more than 3 months, BMI = / <20
• HUGE for those with Osteoporosis: remove rugs, stairway lit, limit alcohol, clean floor, wear shoes, improve safety

Bisphosphonates (Meds)

• Alendronate, ibandronate, risedronate, zoledronate ( all the dronate's)
• Take med in morning on empty stomach at least 30 min before breakfast, take with at least 8 oz of water (NO JUICE, COFFEE, TEA OR MILK as it can decrease effect of med)
• Sit upright for 30 min
• Causes muscle aches = report

Conjugated Estrogen (Premarin) (Meds)

• Used in women who do NOT have a uterus
• Is the Hormonal replacement of choice for women after menopause

Barriers to healthcare:

• Lack of health insurance, fear of negative reactions from health care providers, lack of understanding by healthcare providers of lesbian health issues
• Lesbians see their pcp less than heterosexual so increases risk of them having cervical/ breast cancer
• Concerns about confidentiality, disclosure, discriminatory attitudes & tx, limited access to health care & health insurance often limited understanding as to what their health care risks may be
• Higher risk for: breast cancer, cervical cancer, osteoporosis

Hysterectomy

• Risks: complications related to anesthesia
• Med management: hormone replacement therapy if ovaries were removed, monitor LOC & level of sensation & for SE of anesthesia

CPP- Chronic pelvic pain

• Is defined as pain in the pelvic region that lasts 6 months or longer, is unresponsive to usual pain tx and results in functional or psychological disabilities
• Related to poor posture

PCOS (Polycystic Ovary Syndrome)

• Risk for: hypertension related to insulin resistance
• Tx: Metformin & Hormones

Endometriosis (3)

• Symptoms: bloody urine & dysuria usually present when there are lesions on the bladder

• Endometrial Cancer tx with surgical hysterectomy

STI

• Chlamydia & gonorrhea are top 2 reported STI's and are highest in female & adolescent population

Syphilis

• Primary: chancer, painless lesions
• Secondary: skin rash on hands & feet
• Tertiary: internal organs are damaged, blindness

Candida Vaginitis

• S/S: Itching, irritation in vulva and vaginal areas are primary symptoms, White cheesy vaginal discharge

UTI

• In older women: look for Confusion, delirium, agitation, hallucinations, poor motor skills or dizziness, Falling

Ovarian Cysts

• Some cysts rupture and cause intraperitoneal bleeding.
• Rupture of cysts may be caused by coitus, exercise, lower abdominal trauma or pelvic exam. Woman with intraperitoneal bleeding will experience sudden and severe abdominal pain and may require surgery/blood transfusion

Uterine Prolapse POP

• Cystocele: bulging of bladder into rectum
• Rectocele: bulging of the rectum into bladder
• Actions: explain importance of kegel exercises for improving pelvic muscle strength
• Tx and prevention of constipation such as high fiber, increasing fluid

Urinary Incontinence

• Limit alcohol & caffeine use, kegel exercises
• RF: big ass baby

Breast Cancer

• Most common cancer in women worldwide. If BRCA 1 & 2 positive
• In early stages it usually produces no symptoms and cannot be felt on palpation.
• Women's prognosis improves with early detection & tx
• Yearly screening MRI & mammogram are recommended with women at high risk

Cervical Cancer

• HPV most common STI is the primary cause of cervical cancer
• SE from external radiation: bruising
• Stage II: Cancer has extended beyond the cervix but not into the pelvic wall, has invaded the upper but not lower portion of the vagina

IPV (Intimate Partner Violence)

• Mandatory reporting of intimate partner violence
• Assist client w strategies to protect self from harm