Female Reproductive Health Issues PDF

Dysmenorrhea- Hormonal and Menstrual Alterations Primary dysmenorrhea: Painful menstruation associated with prostaglandin release in ovulatory cycles Excessive prostaglandin F₂α ○ Increased myometrial contractions ○ Constricted endometrial blood vessels ○ Increased nerve hyp...

Dysmenorrhea- Hormonal and Menstrual Alterations Primary dysmenorrhea: Painful menstruation associated with prostaglandin release in ovulatory cycles Excessive prostaglandin F₂α ○ Increased myometrial contractions ○ Constricted endometrial blood vessels ○ Increased nerve hypersensitivity Secondary dysmenorrhea: Related to pelvic pathology & may occur any time in the menstrual cycle Diagnosis: medical history and pelvic exam Treatment: NSAIDs, hormonal contraceptives, exercise, decrease stress, application of heat, acupuncture, thiamine & vitamin E supplements Amenorrhea - Hormonal and Menstrual Alterations Amenorrhea: lack of menstruation; due to pregnancy, hypothalamic dysfunction, polycystic ovarian syndrome, hyperprolactinemia and ovarian failure Primary amenorrhea: Failure of menarche and absence of menstruation by age 13 without development of secondary sex characteristics or by age 15 regardless of presence of secondary sex characteristics Secondary amenorrhea: Absence of menses after previous menstrual periods - Common in early adolescence, pregnancy, lactation, and during perimenopause - Also associated with thyroid disorders, hyperprolactinemia, excessive stress or weight loss, and polycystic ovary syndrome (PCOS) - Pregnancy must be ruled out before any further evaluation Polycystic Ovary Syndrome (PCOS)- Hormonal and Menstrual Alterations One of the most common endocrine disturbances affecting women; leading cause of infertility in North America Diagnosis includes two of the following: - Few or anovulatory menstrual cycles - Elevated levels of androgens - Polycystic ovaries Associated with genetic predisposition and obesity - Insulin resistance, excessive insulin and androgens (messes will all the hormones) Symptoms related to anovulation and hyperandrogenism - Amenorrhea, hirsutism, acne and infertility Treated with oral contraceptives to control irregular cycles, weight loss Premenstrual Syndrome (PMS) & Premenstrual Dysphoric Disorder (PMDD) PMDD considered a severe, sometimes disabling extension of PMS Cyclic physical, psychological, or behavioural changes that impair interpersonal relationships or interfere with usual activities Occurs in luteal phase of the menstrual cycle Multiple theories to explain causes/symptoms - Hormones - Genetics - Environmental Symptomatic treatment Pelvic Inflammatory Disease (PID)- Infection & Inflammation Acute inflammatory process caused by infection; may involve any organ of the upper genital tract… affects the entire peritoneal cavity in severest form - Salpingitis is inflammation of the fallopian tubes Usually caused by STIs that migrate from the vagina to the upper genital tract Risk Factors: Multiple sexual partners, being sexually active at a younger age, previous PID, using douches, and having an IUD for birth control Clinical Manifestations: varies from no pain to sudden, severe abdominal pain with fever; dysuria and irregular bleeding Diagnosis: history, abdominal tenderness, cervical motion tenderness, mucopurulent discharge, STI testing Rapid broad spectrum antibiotic treatment to prevent complications Pelvic Inflammatory Disease (PID)- Infection & Inflammation Vaginitis- Infection & Inflammation Irritation/inflammation usually caused by an infection of the vagina Causes: sexually transmitted pathogens, overgrowth of normal flora, and Candida albicans Acidic nature of the vagina provides some protection - Maintained by cervical secretions and normal flora - Altered by douching, soaps, spermicides, feminine hygiene sprays, deodorized pads or tampons, pregnancy, and diabetes Treatment to develop and maintain acidic environment; administration of antimicrobials or antifungals; symptom relief (pruritus and irritation) Pelvic Organ Prolapse Uterine prolapse: Descent of the cervix or entire uterus into the vaginal canal or completely through the vagina - Grade 1: Not treated unless it causes discomfort - Grades 2 and 3: Cause feelings of fullness, heaviness, and collapse through the vagina Treatment: Pessary (removable mechanical device that holds the uterus in position) Kegel exercises Estrogen therapy Surgery is treatment of last resort Endometriosis Presence of functioning endometrial tissue or implants outside the uterus; responds to hormone fluctuations of the menstrual cycle Pathophysiology is still poorly understood Highly associated with infertility Dyschezia (pain on defecation) is hallmark symptom Treatment to prevent progression, alleviate pain, and Pelvic sites of implantation in endometriosis; restore fertility endometrial cells may enter the pelvic cavity during retrograde menstruation Infertility Inability to conceive after 1 year of unprotected intercourse Female infertility results from dysfunction of the normal reproductive process ○ Menses and ovulation ○ Fallopian tube function ○ Implantation of fertilized egg Initial workup includes semen analysis, determination of ovulation, and hysterosalpingography of the fallopian tubes Treatment aimed toward correction of problems identified Uretritis- Disorders of the Urethra Inflammation of the urethra is usually, but not always, caused by a sexually transmitted infection →Nonsexual origins can be caused by urological procedures, insertion of foreign objects, anatomical abnormalities, or trauma Clinical Manifestations: urethral tingling, itching or burning sensation, urinary frequency and urgency, purulent discharge Diagnosis: urine nucleic acid detection amplification tests for gonorrhea and chlamydia Treatment: antibiotic therapy and avoidance of future exposure or mechanical irritation Urethral Strictures- Disorders of the Urethra Fibrotic narrowing of the urethra caused by scarring →Commonly a result of trauma or untreated or severe urethral infections →Can result in hydronephrosis and kidney failure if severe and prolonged Clinical Manifestations: urinary tract infection symptoms, diminished “force & calibre”, urinary hesitancy, double stream, dribbling after voiding Diagnosis: history & physical, flow rate and cystoscopy Treatment: surgical; urethral dilation Disorders of the Penis Phimosis: inability to retract foreskin from the glans of the penis, frequently caused by poor hygiene or chronic infections → may require circumcision Paraphimosis: inability to replace or cover the glans with the foreskin → surgical emergency to prevent necrosis if severe Peyronie Disease: “bent nail syndrome”; fibrous plaque development in the erectile tissue causing a painful lateral curvature of the penis during erection Priapism: condition of a prolonged penile erection… urological emergency! Balanitis: inflammation of the glans penis; usually associated with prepuce inflammation related to accumulation of smegma Benign Prostate Hyperplasia (BPH) Enlargement of the prostate gland, leading to compression of the urethra Risks: family history, obesity Clinical Manifestations: FUNWISE - Frequency - Urgency - Nocturia - Weak stream - Intermittency (stop/start) - Straining - Emptying (do they feel empty after voiding?) Diagnosis: digital rectal examination and measurement of prostate-specific antigen (PSA), transurethral ultrasound Treatment: medications (tamsulosin), education (double void, avoid fluids before bed, reduce consumption of mild diuretics like caffeine and alcohol) Sexual Dysfunction Impairment of any of all processes of male sexual response (erection, emission & ejeculation) 1. Vascular, endocrine, and neurological disorders 2. Chronic disease, including kidney failure and diabetes mellitus 3. Penile diseases and penile trauma 4. Surgery and pharmacological therapies Treatment: medications (vasodilators; sildenafil *A/E*), cessation of smoking, penile implants, penile revascularization and correction of other anatomical defects Sexually Transmitted Infections (STIs) Reportable infections do not include some of the most prevalent sexually transmitted infections Complications: pelvic inflammatory disease (PID), infertility, ectopic pregnancy, chronic pelvic pain, neonatal morbidity and mortality, genital cancer, and epidemiological synergy with HIV transmission (coinfection, amplifies one another) Although the majority of STIs can be treated, viral-induced STIs are considered incurable Sexually Transmitted Infections (STIs) Bacterial sources - Gonococcal infections - Bacterial vaginosis - Syphilis - Lymphogranuloma - Chlamydial infections Viral sources - Genital herpes Parasitic sources - Trichomoniasis - Human papillomavirus (HPV) - Condylomata acuminata - Scabies - Pediculosis pubis