Female Reproductive Disorders PDF

Care of the Adult Patient with Disorders of Sexuality PART 1 Presented by Mrs. K. Jones-Fraser RN, BScN, Cert. Nsg. Ed. MScN, PhD Candidate  At the end of the session students should be able to:  Give an overview of the Female...

Care of the Adult Patient with Disorders of Sexuality PART 1 Presented by Mrs. K. Jones-Fraser RN, BScN, Cert. Nsg. Ed. MScN, PhD Candidate  At the end of the session students should be able to:  Give an overview of the Female Reproductive System  Elaborate on the disorders of the Objectives female reproductive system based on class discussion and information in text  Discuss information that can be garnered from a health history of the various conditions with 95% accuracy   Outline the Nursing management of adult patients Objectives with disorders of the female reproductive system based on cont. information in text and class discussion Diagram of the Female Reproductive System  The Female Reproductive System  The organs of the reproductive systems are concerned with the general process of reproduction  The organs of reproduction in the females are:  Ovaries  Fallopian tubes (uterine tubes)  Uterus  Vagina  Vulva  Mammary glands (breast) Functions of the female reproductive system  Ovaries – produce secondary oocytes and hormones including progesterone and oestrogen The  Fallopian tubes – transport a Female secondary oocytes to the Reproducti uterus. The site where ve System fertilization occur  Uterus – site for implantation of a fertilized ovum, development of the fetus during pregnancy and labour  Functions of the female reproductive system cont.  Vagina – receives the penis during sexual intercourse The and is a passageway for the Female baby during childbirth Reproducti ve System  Mammary glands – synthesize, secrete and eject milk for nourishment of the newborn  The Female Reproductive System Vagina:  A muscular passageway that leads from the vulva (external genitalia)to the cervix.  It is situated between the urinary bladder and the rectum. The muscular wall allows the vagina to expand and contract. Cervix:  The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. Serves as a protective barrier for the uterus. During childbirth, the cervix dilates to permit the baby to descend from the uterus into the vagina for birth.  Uterus:  The uterus is shaped like an upside-down pear, with a thick The lining and muscular walls. Located Female near the floor of the pelvic cavity. A hollow organ that houses the Reproduct baby during pregnancy. During ive childbirth, the uterine muscles contract to push out the baby. System Each month, unless a fetus has been conceived, the uterine wall sheds its lining  There are 3 sections to the uterus: fundus, corpus and cervix.  Ovaries:  There are 2 ovaries that are the size of an almond. They are located on each side of the uterus within the pelvic bone.  The ovaries produce ova and sex hormones - follicle stimulating The Female hormone (FSH) and luteinizing Reproductive hormone (LH) trigger ovulation System  Ovaries produce estrogen and progesterone which stimulate the lining of the uterus so it can receive a fertilized  Each ovary releases one egg per month.  The Female Reproductive System Fallopian tubes:  Located at the upper corners of the uterus.  There are two fallopian tubes, also called the uterine tubes or the oviducts.  Each fallopian tube attaches to a side of the uterus and connects to an ovary.  Muscular tubes through which eggs released from the ovaries must traverse to reach the uterus.  Mammary glands  The breast is a modified sweat gland with a mass of glandular, fatty and fibrous tissues on the pectoralis The Female muscles in the chest wall. Reproductive System  Mammary glands are the organs that produce milk for the sustenance of a baby.  Major hormones responsible for breast development are estrogen, progesterone and prolactin.  BENIGN BREAST DISEASE Types of benign breast disease  Fibrocycstic breast disease  Mastitis  Fibroadenoma  Gynecomastia in males Disorders of Other types of breast disease the female  Duct Ectasia reproductive BREAST CANCERS system: Breast  Ductal carcinoma - invasive and non- invasive  Medullary carcinoma  Lobular carcinoma  Adenoid cystic carcinoma  Angio sarcoma  Type of sexually transmitted Sexually infections Transmitt  Genital warts  Genital herpes ed  Gonorrhoea Infections  Syphillis  Trichomoniasis  Vulval-vaginal candida  Chlamydia  Pediculosis pubis  Granuloma inguinale  Uterus  Pelvic inflammatory disease (PID)  Infertility  Abortion  Menstrual Problems Disorders of  Endometriosis the female  Menopause reproductive  Uterine prolapse system  Cystocele  Rectocele  Benign and Malignant tumours of:  Cervix  Uterus  Ovary  Fistulas  Vesico-vaginal  Rectovaginal BREAST  Benign Breast Disease  The term benign breast conditions (also known as benign breast diseases) describes many noncancerous disorders that can affect the breast. Types of benign breast disease  Fibrocycstic breast disease  Mastitis  Fibroadenoma  Gynecomastia in males  Fibrocystic Breast Disease Fibrocystic breast disease is a condition of breast tissue characterized by noncancerous breast lumps in the breast Cause  The most significant contributing factor to fibrocystic breast condition is a woman's normal hormonal variation during her monthly cycle.  These hormones are estrogen and progesterone. These two hormones directly affect the breast tissues by causing cells to grow and multiply.  Other hormones such as prolactin, growth factor, insulin, and thyroid hormone act on the breast.  Signs and symptoms  Pain or discomfort in both breasts Fibroc  The pain commonly comes ystic and goes with the period, but can last through the Breast whole month Diseas  Breasts that feel full, swollen, and heavy e  Pain or discomfort under the arms  Thick or lumpy breasts  Diagnostic test  Self breast examination Fibrocystic Breast  Breast ultrasound/ mammogram Disease  Breast biopsy   Pharmacologic agent – anti- inflammatory medications, e.g Fibrocyst acetaminophen and non- steroidal anti-inflammatory ic Breast medications (NSAIDs) Disease  Treat other underlying conditions such as diabetes  Hormone regulation therapy – women with irregular periods  Nursing management  Assessment Fibrocystic  Education Breast  Interventions – Disease medication administration  Mastitis  Mastitis is an infection of the breast tissue that results in breast pain, swelling, warmth and redness of the breast. Etiology  A blocked milk duct - if a breast doesn't completely empty at feedings  Bacteria entering your breast - bacteria from your skin's surface and baby's mouth can enter the milk ducts through a break or crack in the skin of your nipple or through a milk duct opening.  Bacteria can multiply, leading to infection.  Signs and symptoms  Breast tenderness or warmth to the touch  Generally feeling ill (malaise)  Swelling of the breast  Pain or a burning sensation Mastitis continuously or while breast- feeding  Skin redness, often in a wedge- shaped pattern  Fever of 38.3 C (101 F ) or greater  Management  Pharmacologic agents – antibiotics for infection, analgesic such as acetaminophen ,ibuprofen  Adjustments to your breast- feeding technique – mother is Mastitis advised to fully empty your breasts during breast-feeding and ensure the infant latches on correctly.  Self-care - rest, continue breast-feeding and self breast examination  Nursing management  History  Education Mastitis  Problem identification  Diagnosis  Interventions  Fibroadenomas - are solid, noncancerous breast tumors that most often occur in women under the age of 30.  A fibroadenoma is a firm, smooth, rubbery or hard lump with a well-defined Fibroadenom shape. It moves easily under as the skin when touched and is usually painless. Typically about the size of a marble, fibroadenomas can enlarge during pregnancy and breast-feeding.  Signs and Symptoms  Round masses with distinct borders  Easily moved Fibroadenom as  Firm or rubbery  Painless  Feel like a marble  Investigations  History  Physical examination  Mammography  Breast ultrasound  Fine-needle aspiration - a thin Fibroadenom needle inserted into the breast as lump if fluid comes out, the lump is said to be a cyst.  Core needle biopsy - a large needle is used to obtain tissue samples from the lump to send for analysis.  Management Fibroadenom  Surgery - lumpectomy as or excisional biopsy.  Gynaecomastia -is the abnormal development of large mammary glands in males resulting in breast enlargement Gynaecomast Causes of gynaecomastia ia  Hormone imbalance - imbalance between the sex hormones testosterone and oestrogen. Oestrogen causes breast tissue to grow  Other causes  Gynaecomastia can be caused by - medication, such as anti-ulcer drugs  Alcohol consumption Gynaecomast ia  Kidney failure or liver disease  Lumps or infection in the testicles  Clinical manifestations  Signs vary from a small Gynaecomast amount of extra tissue ia around the nipples to more prominent breasts  Tender or painful breast   Duct ectasia of the breast or (mammary duct ectasia) or (Plasma cell mastitis) is a condition in Duct Ectasia which the lactiferous duct becomes blocked or clogged.  Duct Ectasia  Etiology  Breast tissue changes due to aging - the breast tissue changes from mostly glandular to mostly fatty in a process called involution. These normal breast changes can sometimes lead to blockage of a milk duct and the inflammation associated with mammary duct ectasia.  Smoking - cigarette smoking may be associated with widening of milk ducts, which can lead to inflammation and, possibly, mammary duct ectasia.  Nipple inversion - inverted nipple may obstruct milk ducts, causing inflammation and infection. DIAGNOSIS ULTRASOUND - DUCTOGRAPHY - A DUCTAL LAVAGE A MAMMOGRAM FACILITATED THE SMALL AMOUNT OF AND CYTOLOGY- DIFFERENTIATION CONTRAST MEDIUM CYTOLOGY OF BETWEEN BENIGN IS INJECTED INTO A CELLS OBTAINED AND MALIGNANT MILK DUCT AND A BY DUCTAL LAVAGE LESIONS. MAMMOGRAM PERFORMED. Duct Ectasia  Duct Ectasia  Management  Pharmacologic agents – antibiotics, analgesics  Surgery - the affected milk duct may be surgically removed  Breast cancers Types of breast cancers  Ductal carcinoma - invasive and non-invasive  Medullary carcinoma  Lobular carcinoma  Adenoid cystic carcinoma  Angio sarcoma  Breast cancers Two major groups of Breast cancer: 1. Noninvasive Carcinoma  Ductal Carcinoma In Situ (DCIS – intraductal carcinoma),  Lobular carcinoma in situ(LCIS) 2. Invasive Carcinoma- Gain access to the supporting tissue between ducts, blood vessels, and lymph nodes  Invasive ductal carcinoma  Medullary carcinoma  Colloid carcinoma  Tubular carcinoma  Ductal carcinoma is a type of tumor that primarily presents in the ducts of a gland.  There are two types of ductal Ductal carcinoma Carcino  Ductal carcinoma in situ, (also intraductal ma carcinoma)  Invasive ductal carcinoma  Clinical manifestations  Ductal carcinoma (DCIS) does not cause any signs or symptoms in most cases. Ductal  Sometimes present with: Carcino  a breast lump ma  bloody nipple discharge  Etiology  Unknown  Genetic  Risk factors  Increasing age Ductal  Personal history of benign breast disease, Carcino such as atypical hyperplasia ma  First pregnancy after age 30  Taking combination estrogen-progestin hormone replacement therapy after menopause Ductal Carcinoma  Surgery - lumpectomy and mastectomy  Radiation therapy  Pharmacologic agent - Tamoxifen (blocks the action of estrogen)  Ductal Carcinoma Nursing management  Pre-operative -obtain informed  Post-operative - inspect dressing anteriorly and posteriorly  Encourage coughing exercises and turning schedule every two hours  Provide psychological and emotional support  Explain to the patient that she may experience phantom breast syndrome  Administer medication as Ductal ordered Carcinoma Prepare patient for radiation therapy   Tubular carcinoma is a rare type of invasive ductal carcinoma of the breast. Tubular  It takes its name from its carcinoma microscopic appearance, in which the cancer cells resemble small tubes  Tubular carcinoma SIGNS AND NO CLINICAL SIGNS SYMPTOMS: AND SYMPTOMS  Diagnosis Tubular  Mammogram carcino  Breast ultrasound ma  Biopsy   Management  Lumpectomy (surgery to remove a Tubular small tumor and a margin of tissue) carcino  Radiation therapy ma  Hormonal therapy   Colloid carcinoma - sometimes called 'muninous' or mucin- producing carcinoma, is a type of invasive ductal breast cancer. The distinguishing feature of colloid carcinoma is the production of Colloid mucous. Carcino ma  Most mucinous carcinomas of the breast are estrogen-receptor positive. This type of breast cancer rarely spreads to the lymph nodes.  Signs and Symptoms Slightly bumpy Colloid water balloon Carcinoma mass Tenderness Colloid Carcinoma Diagnostic investigations  History  Physical examination  Mammogram  Breast ultrasound  Open surgical biopsy  Colloid Carcinoma Management  Surgery-lumpectomy, mastectomy  Radiation  Chemotherapy- doxyrubicin (cytotoxic agents)  Hormone Therapy- (for hormone- sensitive cancers)  Nursing management History Colloid Carcinoma Physical examination Diagnosis – Body image disturbance etc.   Breast reconstruction - is a Breast type of surgery for women who Reconstruct have had a breast removed ion (mastectomy).  The surgery rebuilds the breast mound so that it is about the same size and shape as it was before.  The nipple and the darker area around the nipple (areola) can also be added.  Types of breast reconstruction methods Breast  Implant procedures Reconstruct ion  Tissue flap procedures  Implant procedures  Types of implants Breast 1. Saline-filled implant - is a Reconstructi silicone shell filled with sterile on saline 2. Silicone gel-filled implants Types of Implants Picture of Tissue Expanders  Tissue Expander  Tissue flap procedures - use tissue from the tummy, back, thighs, or buttocks to rebuild the breast.  The two most common types of tissue flap procedures are the: Breast 1. TRAM flap (or transverse Reconstructi rectus abdominis muscle on flap) - uses tissue from the lower tummy area 2. Latissimus dorsi flap - uses tissue from the upper back Latissimus Dorsi Flap  Transverse Rectus Abdominis Mus cle Flap   Nursing management  Preoperative Breast Nursing Diagnosis - Fear related to Reconstructi change of body image; scarring, loss on of body part  Postoperative – Risk for infection, Acute pain   Interventions The breast flap should be assessed for color, warmth, capillary refill, and arterial and venous blood flow, as well as erythema, drainage, signs of Breast infection Reconstructi  Dark redness of the flap may indicate on obstruction to venous outflow.  A pale or mottled breast may indicate poor arterial blood flow.  Assess for excessive swelling SEXUALLY TRANSMITTE D INFECTIONS   Genital warts are soft growths on the Genital skin and mucus membranes of the Warts genitals.  Genital warts are sometimes referred to as condyloma acuminata or venereal warts  They may be found on the penis, vulva, urethra, vagina, cervix, and around the anus.  The virus that causes genital warts is called human papilloma virus (HPV).  The signs and symptoms  Small, flesh-colored or gray swellings in the genital area  Several warts close together that take on a cauliflower shape Genital Warts  Men and women with genital warts will often complain of painless bumps, itching, and discharge.  Bleeding with intercourse  Risk factors Genital  Having unprotected sex with Warts multiple partners  Having had another sexually transmitted infection  Having sex with a partner whose sexual history you don't know  Becoming sexually active at a young age  Investigations  History  Physical examination  Pap smear  Aceto-whitening - the application of Genital 5% acetic acid solution to the area Warts of suspicion for about 5-10 minutes. Infected areas will turn white.  Colposcopy – magnify the lesion  Genital Warts Management  Medications - Imiquimod (Aldara, Zyclara), Podophyllin and podofilox (Condylox), Trichloro-acetic acid (TCA  Surgery - surgical excision of warts  Electrocautery - uses an electrical current to burn off warts.  Laser treatments - uses an intense beam of light to burn off warts  Etiology  Genital herpes is caused by the herpes simplex virus (HSV). There are two types - HSV-1 and HSV-2.  Most genital herpes infections are caused by HSV-2. Genital  HSV-1 is the usual cause of "fever herpes blisters“ around the mouth and can be transmitted from person to person through kissing  HSV-1 can cause genital herpes infections through oral sexual contact  Genital herpes  Genital herpes are highly contagious.  Anyone with active disease should avoid any sexual contact when sores are present.  Even the use of a condom does not prevent the spread of disease because not all sores are covered by the condom.  Signs and symptoms  Signs of genital herpes tend to develop within three to seven days following contact with an infected person.  Sores around the penis  Lesions may be visible outside Genital the vagina herpes  Occur inside the vagina where they can cause vaginal discharge  The ulcers or blisters may also be found anywhere around the perineum and in and around the anus. Other signs and symptoms  Fever  Muscle aches,  Headaches (may be Genital severe), Herpes  Dysuria (painful urination)  Swollen and tender lymph nodes in the groin  Diagnosis  History  Physical examination  Wound swab culture of the Genital Herpes virus; Genital Herpes Management  Pharmacologic agent - antiviral medications include: acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex).  Prevention Genital  Safe sex practices (use of a condom) should be used between disease herpes outbreaks to lessen the chance of spreading disease to a sexual partner.   Gonorrhea also called the "clap" is a contagious disease transmitted through sexual contact with an Gonorrho infected person. ea Etiology  Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in mucus membranes of the body.  Gonorrhea bacteria can grow in the warm, moist areas of the reproductive tract  The bacteria can also grow in the mouth, throat, and anus.   Gonorrhea may also be spread by contact with infected body fluids, Gonorrho so that a mother could pass on the ea infection to her newborn during childbirth.  Gonorrhoea Clinical manifestations  Greenish yellow or whitish discharge from the vagina  Lower abdominal or pelvic pain  Burning when urinating  Conjunctivitis  Bleeding between periods  Spotting after intercourse  Swelling of the vulva (vulvitis)  Gonorrhoea Clinical manifestations cont.  Burning in the throat (due to oral sex)  Swollen glands in the throat (due to oral sex)  Painful or swollen testicles Gonorrhoea  Investigations  A swab of the discharge is sent to the laboratory  Rectal culture in both men and women  Blood cultures Gonorrho Management  Medication – oral or ea injectables antibiotics  Complications  Untreated gonorrhea can cause pelvic inflammatory disease Gonorrho  Lead to infertility ea  Ectopic pregnancy  Epididymitis – inflammation of the testicles  Gonorrhea can spread to the blood or joints.  Gonorrhoea Prevent  Use condoms correctly every time you have sex.  Limit the number of sex partners  Practice sexual abstinence or limit sexual contact to one uninfected partner.  If there are signs of the infection, avoid sexual contact and seek medical attention.   Syphilis is a sexually transmitted infection caused by the bacteria Treponema pallidum  Pregnant women with the Syphilis disease can spread it to their baby. This disease can cause abnormalities or even death to the child.  Signs and symptoms occurs in three distinct stages:  Early or primary syphilis present with:  one or more sores. Syphilis  the sores resemble large round bug bites and are often hard and painless.  they occur on the genitals between 10-90 days after exposure.   The secondary stage - last one Syphilis to three months and begins within six weeks to six months after exposure.  Rosy "copper penny" rash on the palms of the hands and soles of the feet.  Moist warts in the groin,  White patches on the inside of the mouth,  Swollen lymph glands  Fever, and weight loss.   Latent syphilis. This is where the infection lies dormant (inactive) without causing symptoms. Syphilis  Tertiary syphilis - if untreated can result in paralysis, blindness, dementia, deafness, impotence, and death  Diagnosis History Syphilis Physical examination Blood test   Management  Pharmacologic agents - a single dose of penicillin. Syphilis  In case of an allergy to penicillin tetracycline or doxycycline is given.   Trichomoniasis (commonly referred to as "trich") is a common, curable sexually transmitted disease.  Trichomoniasis is caused by a one-celled Trichomonia parasite, Trichomonas- sis vaginalis  Trichomoniasis affects both women and men.  The most common location of the infection in women is the vagina, and in men it is the urethra.  Signs and symptoms  Female  Yellow-green vaginal Trichomonia discharge sis  Fishy odor  Dysuria  Pain during sexual intercourse  genital itching or irritation.  Signs and symptoms cont.  Men  Usually do not show symptoms Trichomonia  Some may experience discharge sis from the penis or burning during urination or ejaculation.  Swelling in the scrotum  Diagnostic tests  In women  A pelvic examination shows red blotches on the vaginal wall or cervix.  A swab of vaginal fluids Trichomoni  Papanicolaou test (pap smear) asis  In men:  Men are treated if the infection is diagnosed in any of their sexual partners. Men may also be treated if they have ongoing symptoms of urethral burning or itching despite treatment for gonorrhea and chlamydia. Trichomoni Management  Pharmacologic agent - metronidazole asis (Flagyl), oral or vaginal pessaries   Chlamydia is a bacterial Chlamy infection transmitted dia through sexual intercourse.  Cause  Chlamydia is an infection caused by the  bacterium Chlamydia trachomatis   Clinical manifestations  Bleeding after sexual relations or between menstrual periods Chlamy  Lower abdominal pain dia  Dysuria  Vaginal discharge (white)  Men - may not show symptoms. f infected men.  Discharge from the penis  Dysuria  Inflammation or infection of a duct in the testicles  Diagnosis Chlamy  Physical Examination dia  History  Diagnostic Tests - samples of the discharge, urine cultures  Papanicolaou test  Treatment Chlamy  Medications - such dia as azithromycin (Zithromax), and doxycycline   Candida vulvovaginitis or vaginal thrush is an infection of the vagina’s mucous membranes by Candida albicans  Candida is a microorganism that's Vulval normally present in the vagina. The vagina naturally contains a balanced vaginal mix of yeast and bacteria. candida  Lactobacillus bacteria produce acid, which discourages overgrowth of yeast in the vagina. But disruption of the healthy balance can result in an overgrowth of yeast.  Clinical manifestations  Itching of the vulva  thick white curd-like discharge from the vagina Vulval  Irritation in the region of the vulva vaginal and vagina  Redness and swelling of the vulva candida  Burning on passing urine  Dyspareunia (pain during sexual intercourse) Risk of developing vulval vaginal candida  Antibiotic use Vulval  Increased estrogen levels vaginal  Uncontrolled diabetes candida  Impaired immune system – immuno compromised (HIV infection) Vulval vaginal candida Diagnostic investigations  History  Physical examination  Pelvic exam  Sample of vaginal secretions for testing  Management  Medication- clotrimazole (Lotrimin), miconazole Vulval vaginal (Monistat) and terconazole candida (Terazol)vaginal inserts, and fluconazole (Diflucan) to be taken by mouth.  Prevention  Avoid douching.  Don't use scented tampons, pads, bubble baths or feminine hygiene sprays.  Wear cotton underwear and Vulval vaginal loose-fitting pants or skirts. candida  Change out of wet clothes, such as swimsuits or workout attire, as soon as possible.  Stay out of hot tubs or very hot baths.   Pediculosis pubis (also known as "crabs" and "pubic lice") is a disease caused by the Pthirus pubis, a parasitic insect. Signs and symptoms Pediculosis  Itching and burning of the pubic pubis area.  Intense or prolonged scratching may lead to skin injuries that may become infected by bacteria.  Diagnosis Pediculo  History sis pubis  Physical examination- A diagnosis of any type of pediculosis rests on the observation of eggs (nits), nymphs, or mature lice Management  Medication  Environmental control measures  Nursing management of sexually transmitted infections Sexually  History Transmitt ed  Physical examination Infections  Problem identification/diagnosis  Interventions Genital warts Genital herpes Gonorrhoea Syphilis Chlamydia CONDITIONS OF THE UTERUS, CERVIX, OVARIES, FALLOPIAN TUBES PART 2   Pelvic inflammatory disease (PID) is a term for inflammation of the uterus, fallopian tubes, and ovaries Pelvic  Causes Inflammat  Pelvic inflammatory disease is ory most frequently caused by Disease bacteria that are transmitted through sexual contact. Bacteria that cause gonorrhea and chlamydia (Chlamydia trachomatis and Neisseria gonorrhoeae)  Clinical manifestations  Lower abdominal pain or tenderness  Back pain Pelvic  Abnormal uterine bleeding Inflammat  Unusual or heavy vaginal ory discharge Disease  Dysuria  Painful sexual intercourse  Fever  Nausea and vomiting  Diagnosis Pelvic  History inflammat  Physical examination ory  Laboratory tests - urine or serum disease pregnancy test  Urinalysis to check for bladder and kidney infection  Cervical cultures for gonorrhea and chlamydia  Complete blood count  Diagnosis cont.  A pelvic ultrasound – to detect tubo-ovarian abscesses, ovarian cysts, and ectopic pregnancy Pelvic  Exploratory Surgery - laparoscope inflammat ory Management disease  Medical Treatment - medication e.g doxycycline, (Vibramycin, Monodox), 100 mg orally or IV every 12 hours).  Surgery - remove or drain a tubo- ovarian abscess if present.  Definitions  Infertility is defined as difficulty in conceiving or becoming pregnant  The WHO (2004) defines infertility as the inability to conceive a child. Infertilit  A couple may be considered infertile if, y (male after two years of regular sexual and intercourse, without contraception, the female) woman has not become pregnant (and there is no other reason, such as breastfeeding or postpartum amenorrhoea).   Types of infertility  Primary infertility - is infertility in a couple who have never had a child.  Secondary infertility - is failure to conceive following a previous Infertility pregnancy. (male and female) Causes of Infertility in Men  Low semen quality  Low sperm count  Immotile sperm   Female causes  Ovaries do not mature and release eggs. Infertility  Tubal blockage (male and  Pelvic inflammatory disease female  Previous tubal ligation  Endometriosis  Advanced maternal age  Causes in both sexes  Genetic factors  Disease conditions - diabetes Infertility mellitus, thyroid disorders, adr enal disease (male and  Environmental factors - female toxins such as glues, volatile organic solvents or silicones, physical agents, chemical dusts, and pesticides  Tobacco smokers  Infertility Symptoms in Men  Changes in hair growth Infertilit  Changes in sexual desire y (male  Low sperm count  Pain, lump, or swelling in the and testicles female)  Problems with sexual function (erection and ejaculation)  Small, firm testes  Infertility (male and female) Management  Treatment depends on the cause of infertility  Counselling,  Fertility treatments, which include in vitro fertilization.  Drugs used include Clomiphene citrate, Human menopausal gonadotropin, Follicle-stimulating hormone, Human chorionic gonadotropin,  Infertility (male and female)  Nursing management  History  Problem identification  Interventions   Endometriosis is a medical condition in which cells from the lining of the uterus (endometrium) Endometrio appear and flourish outside sis the uterine cavity, most commonly on the peritoneum which lines the abdominal cavity  Cause  The cause of endometriosis is unknown  Retrograde menstruation Endometrio  Genetic sis  Direct transfer of endometrial tissues during surgery e.g Cesarean section scars   Signs and symptoms  Painful periods  Cramps for a week or two before menstruation and during menstruation; cramps may be steady and range from dull to Endometrio severe)  Pain during or following sexual sis intercourse  Pain with bowel movements  Pelvic or low back pain that may occur at any time during the menstrual cycle  Infertility   Diagnosis  History  Physical exam - including a Endometri pelvic exam osis  Transvaginal ultrasound  Pelvic laparoscopy   Treatment  Nonsteroidal anti-inflammatory drugs (NSAIDs),  Hormone medications to stop the Endometri endometriosis from getting worse (Progesterone) osis  Surgery to remove the areas of endometriosis or hysterectomy and ovarectomy   Premature emptying of the pregnant uterus before the end of 28 weeks (Wells & Weller, 2004)  Types of abortion  Spontaneous - Spontaneous abortion, also Aborti known as miscarriage, is the unintentional on expulsion of an embryo or fetus before the 24th week of gestation  Induced – medically -misoprostol  Surgical – dilatation and curetage, manual vaccum aspiration  Self induced – illegal means   Reasons women consider abortion are:  Birth control (contraceptive) failure  Inability to support or care for a child.  To end an unwanted pregnancy  To prevent the birth of a child with birth defects or severe medical Abortion problems..  Pregnancy resulting from rape or incest.  Physical or mental conditions that endanger the woman's health if the pregnancy is continued.  Exams before an abortion  A physical exam  Laboratory tests - A urine pregnancy test. A blood test (anemia), blood type, rhesus status, sexually transmitted diseases (STDs) Abortion  A Pap smear to check for cervical cell abnormalities  An ultrasound - to check the uterus size and shape and to make sure the pregnancy is in the uterus.  Nursing management  History  Physical examination  Counseling Abortion  Referral to support group  After procedure  Monitor vital signs, per vaginal loss  Counselling  Menopause  Menopause is defined as the state of an absence of menstrual periods for 12 months.  Menopause is the time in a woman's life when the function of the ovaries ceases.  The average age of menopause is 51 years old.  Most women reach menopause between the ages of 45 and 55, but menopause may occur as earlier as the 30s or 40s or may not occur until a woman reaches her 60s.   Conditions that can affect the timing of menopause  Certain medical and surgical conditions can influence the Menopaus timing of menopause. e  Surgical  Oophorectomy -the surgical removal of the ovaries  Hysterectomy -the ovaries are often removed together with the removal of the uterus.   Cancer chemotherapy and Menopau radiation therapy se  Premature ovarian failure  Premature ovarian failure is defined as the occurrence of menopause before the age of 40. It may be related to autoimmune diseases or inherited (genetic) factors.  Signs and symptoms Menopau  Irregular vaginal bleeding se  Hot flashes  Night sweats  vaginal dryness and itching  Dyspareunia (pain with sexual intercourse )  Weight gain  Fatigue  Changes in mood  Management Menopau  Hormone therapy - estrogen se and progesterone therapy  Oral contraceptive pills  Vaginal estrogen cream  Antidepressant medications - fluoxetine (Prozac),sertraline (Zol oft   Local (vaginal) hormone and non- hormone treatments  There are also local (meaning applied directly to the vagina) hormonal Menopau treatments for the symptoms of vaginal estrogen deficiency. se  Local treatments include the vaginal estrogen ring, or vaginal estrogen tablets. Local and oral estrogen treatments are sometimes combined for this purpose.  Cervical cancer is a malignant neoplasm arising from cells originating in the cervix uteri. Etiology  Human papiloma virus (HPV) Cervical  Sexual activity - becoming sexually Cancer active at an early age  Smoking  Weakened immune system  Multiple partners  Signs and symptoms Cervical  Vaginal bleeding This is any bleeding from the vagina other than during Cancer menstruation.  Abnormal vaginal discharge Cancer of the cervix  Diagnostic investigations  History Cervical  Physical examination Cancer  PAP smear  A cervical biopsy  Colposcopy   Management Cervical  Surgery Cancer  Radiation therapy  Chemotherapy  A combination of these methods   Nursing management Cervical  History Cancer  Nursing diagnosed  Intervention  Evaluation   Vesico-vaginal  Recto-vaginal  Vesico-vaginal fistula - is an Fistulas abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault.  Etiology  Obstetric manipulation – Vesico- cephalo-pelvic disproportion vaginal  Gynecologic surgery - fistula hysterectomy  Radiation therapy  Invasive cancer of the cervix.  Clinical manifestations Vesico-  Urinary incontinence vaginal  Uncontrolled leakage of urine fistula into the vagina  Vaginal discharge  Investigations  History  Cystoscopy -reveals the fistulous Vesico- opening between the bladder and vaginal vagina. fistula  Vaginography -is performed by inserting a catheter into the vagina, instilling a radio-opaque solution and then viewing on an x-rays  Management  For very small fistulae, an Vesico- indwelling foley catheter for vaginal about 4 weeks may result in fistula closure.  Surgery  Nursing management Nursing diagnosis – acute pain, risk for infection  Postoperative care Vesico-  A light vaginal pack for 24 hours. vaginal  Foley catheter is left for about 14 days. fistulaVesic  Administer anti-spasmodics - to o-vaginal prevent bladder spasms and fistula damage to the repair site.  Antibiotics  Educate - to avoid intercourse for at least 6 weeks after surgery to allow complete healing of the repair site.  Recto-vaginal fistula  A recto-vaginal fistula is an abnormal connection between the rectum and the vagina. Etiology  Injury during childbirth  Surgery - uterus  Cancer  Inflammatory bowel disease – e.g Crohn's disease  Clinical manifestations  Dyspareunia  Vaginal or urinary tract infections  Passage of gas, stool or pus Recto-vaginal from the vagina fistula  A foul-smelling vaginal discharge  Irritation or pain in the vulva, vagina and the perineum  Diagnostic tests Recto-  History vaginal  Physical examination fistula  Magnetic resonance imaging (MRI)  Anorectal ultrasound  Management Recto-  Treatment for a recto-vaginal vaginal fistula depends on its cause, size, location and effect on fistula surrounding tissues  Medication – antibiotics for infection  Surgery - to close the fistula   Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever, K.H, (2008). Textbook of medical and surgical nursing. Philadelphia Reference PA: Lippincott Williams & Wilkins. s  Tortora, G.J, & Grabowski, S., (2002). Principles of anatomy and physiology. USA: John Wiley & Sons.