2Lesson Objectives (1 of 2) Recognize and manage female genital problems, including vaginitis, vulvar irritation, problems with urination, missed menses, heavy or prolonged bleeding, bleeding with pregnancy, pain due to infections, ruptured cysts or ectopic pregnancy, and pain associated with pregnancy.Know how to perform an emergency delivery.Understand general considerations for pregnancy and wilderness travel.
3Lesson Objectives (2 of 2) Recognize and manage male genital problems, including problems with urination, bloody urine, frequent urination, inability to urinate, testicular pain, pain and swelling of the foreskin, and kidney stones.List guidelines for evacuating victims with genitourinary problems.
4Overview (1 of 4)Term genitourinary refers to the reproductive and urinary systems.
6Overview (3 of 4) Female reproductive system Ovaries Fallopian tubes UterusVagina
7Overview (4 of 4) Male reproductive system Testicles Prostate Spermatic cordsPenis
8Female Problems (1 of 26) Vaginitis Occurs when the normal balance of microbes in the vagina is altered.Common causes include yeasts, bacteria, or protozoa.Vaginal infections are uncomfortable but not usually dangerous.
9Female Problems (2 of 26) Vaginitis What to look for: Vaginal soreness, burning, and itchingIncreased vaginal dischargePain with urination
10Female Problems (3 of 26) Vaginitis What to do: Women should wear cotton underwear and loose-fitting pants.Irrigate the vulva with clean water several times daily.Use vaginal antifungal medication.
11Female Problems (4 of 26) Vulvar irritation The vulva is the area of external folds around the vaginaCan be caused by allergic reaction or irritation.
12Female Problems (5 of 26) Vulvar irritation What to look for: Vulvar soreness, burning, and itchingVulvar rednessPain with urination
13Female Problems (6 of 26) Vulvar irritation What to do: Avoid contact with irritating substances.Keep affected area clean.Apply hydrocortisone cream.
14Female Problems (7 of 26) Problems with urination: In absence of vaginitis, vulvitis, or sores, pain with urination is usually caused by urinary tract infection.
15Female Problems (8 of 26) Problems with urination: What to look for: Frequent, burning urinationLow abdominal pain and crampingCloudy, bloody, or foul-smelling urine
16Female Problems (9 of 26) Problems with urination: What to do: Drink water until the urine is pale yellow.Drink acidic fluids or juices and take vitamin C.Avoid sexual intercourse.
17Female Problems (10 of 26) Missed menses Temporary absence of menstrual periods is not necessarily abnormal.Irregularity or absence of menstrual periods can result from stress, illness, starvation, and eating disorder.Heavy, regular exercise can suppress ovulation and menstruation.
18Female Problems (11 of 26) Missed menses What to look for: History of unprotected intercourse, breast tenderness, nausea or morning sickness (possible pregnancy)Stress, heavy exerciseSevere weight loss due to poor eating
19Female Problems (12 of 26) Missed menses What to do: A missed period usually requires no treatment.The woman should consult a doctor if periods do not occur for 3 months.
20Female Problems (13 of 26) Heavy or prolonged bleeding What to look for:Signs and symptoms of pregnancyAmount and duration of bleedingPale skin, nails, and lipsWeaknessSigns and symptoms of shock
21Female Problems (14 of 26) Heavy or prolonged bleeding What to do: Have the woman rest.Give the victim generous amounts of fluids to drink.Seek medical care if bleeding saturates a pad every 3 hours or less over a 24-hour period or if the woman becomes pale and weak.
22Female Problems (15 of 26) Bleeding while on hormonal contraceptives Irregular light bleeding is common in woman who take low-dose birth control pills.
23Female Problems (16 of 26) Bleeding with pregnancy Bleeding in a pregnancy of less than 12 weeks suggests possible miscarriage.Bleeding in a pregnancy of more than 12 weeks occurs with miscarriage, labor, and abnormalities of the placenta.
24Female Problems (17 of 26) Bleeding with pregnancy What to look for: Length of time since last periodAmount of bleeding: spotting or free-flowingLow abdominal painSigns and symptoms of shock
25Female Problems (18 of 26) Bleeding with pregnancy What to do: If less than 12 weeks pregnant and bleeding remains light and painless, have victim avoid physical exertion until bleeding stops.Seek medical care or evacuate if there is heavy bleeding, the woman passes tissue vaginally, there is low abdominal pain, she is more than 12 weeks pregnant, or she becomes weak or pale.
26Female Problems (19 of 26) Low abdominal pain Precise cause cannot be determined in the wilderness.Seek medical care if the woman is obviously sick and becoming worse.
27Female Problems (20 of 26) Pain due to infections What to look for: Low abdominal painFeverNausea and vomitingDiarrhea
28Female Problems (21 of 26) Pain due to infections What to do: Give the victim as much fluid as tolerated.If victim has increasing or constant pain, fever, nausea, and vomiting, seek medical care.
29Female Problems (22 of 26)Pain with internal bleeding from ruptured cyst or ectopic pregnancyIf fertilized egg becomes lodged in fallopian tube, an ectopic pregnancy results.Ovarian cysts can rupture, causing abdominal pain, internal bleeding, and signs of peritonitis.
30Female Problems (23 of 26)Pain with internal bleeding from ruptured cyst or ectopic pregnancyWhat to look for:Low or generalized abdominal painNauseaSigns of blood loss or shock
31Female Problems (24 of 26)Pain with internal bleeding from ruptured cyst or ectopic pregnancyWhat to do:Keep the woman lying at rest.Have her walk out of the area if she is capable and help is far away.If she is unable to walk, send for help and evacuate.
32Female Problems (25 of 26) Pain associated with pregnancy What to look for:Time since last periodRecurring painsSigns of blood loss of shock
33Female Problems (26 of 26) Pain associated with pregnancy What to do: Make sure woman is well hydrated and rests.If more than 5 months pregnant with frequent cramping, drink a quart of water over 20 minutes.
34Emergency Delivery (1 of 4) What to look for:Regular contractions occurring every 4 minutes.Mother feels the urge to push or move her bowels.Baby’s head or other body part is visible.
35Emergency Delivery (2 of 4) What to do:Have the mother lie or squat in a clean area.Mother and rescuers should wash hands if possible.Have mother push with contractions and rest in between.Apply gentle, firm pressure to the baby’s head.
36Emergency Delivery (3 of 4) What to do:If umbilical cord is wrapped around the baby’s neck, unloop it.If any body part other than the head comes out first, evacuate immediately.After infant is delivered, tie off umbilical cord in two places but do not cut it.
37Emergency Delivery (4 of 4) What to do:Hold baby facedown with face lower than body to allow drainage of fluids.Dry the baby and keep warm.Placenta should deliver within 15 minutes.If mother continues to bleed heavily after delivering the placenta, massage the uterus firmly.
38Pregnancy and Wilderness Travel—General Considerations Healthy pregnant women who are active before they become pregnant can usually continue to exercise moderately during pregnancy.Pregnant women should avoid overheating and should maintain adequate hydration.Avoid activities that pose a risk of abdominal trauma, high altitudes, and scuba diving.
39Male Problems (1 of 15) Problems with urination What to look for: Frequent, painful urinationPus at the end of the penis
40Male Problems (2 of 15) Problems with urination What to do: Treat urinary tract infections accordingly.If the victim has a sexually transmitted disease, he should avoid sex and seek medical care.
41Male Problems (3 of 15) Bloody urine What to look for: Pink or red urineSevere back or flank pain (kidney stone or infection)FeverInability to urinate
42Male Problems (4 of 15) Bloody urine What to do: Give victim several extra quarts of water per day unless he is unable to urinate.Have the victim walk out of the wilderness if there is no pain or fever.Evacuate if there is high fever with flank pain.
43Male Problems (5 of 15) Frequent urination What to look for: Fever, chills, flank pain, and/or burning with urinationConstant thirstFrequent small amounts of urine
44Male Problems (6 of 15) Frequent urination What to do: Increase water intake unless you believe there is an obstruction.Give vitamin C.If infection is likely, victim should take antibiotics if he has them.Seek medical care.
45Male Problems (7 of 15) Inability to urinate What to look for: Painfully full bladderInability to pass any urine or frequent small amounts without relief
46Male Problems (8 of 15) Inability to urinate What to do: Stop any medications for allergies, congestion/colds, stomach cramps, motion sickness, and sleep medications.Limit fluid intake.Have victim sit in warm water.If victim is still unable to urinate, evacuate.
47Male Problems (9 of 15) Testicular pain What to look for: Severe pain in the testicle.Affected testicle is firm and swollen.Difficulty urinating because of pain.
48Male Problems (10 of 15) Testicular pain What to do: If twisting is suspected, attempt untwisting.If pain does note resolve within a few minutes, evacuate.If infection is suspected, use warm compresses and give antibiotics if available.
49Male Problems (11 of 15) Pain and swelling of foreskin Foreskin can become inflamed and it may become impossible to move foreskin back and forth over the penis.
50Male Problems (12 of 15) Pain and swelling of foreskin What to do: Have victim gently compress tissue and try to move it.Wash the area with mild soap cleaning beneath foreskin as well.Dry the area and apply antifungal cream and/or antibiotic ointment.
51Male Problems (13 of 15) Pain and swelling of foreskin What to do (continued):For suspected infection, administer antibiotics if available.Seek medical care if unable to urinate or relieve pain and swelling.
52Male Problems (14 of 15) Kidney stone What to look for: Sudden onset of pain in the flankSevere pain that causes restlessness and vomitingBloody urine
53Male Problems (15 of 15) Kidney stone What to do: Administer pain medication.Increase fluid intake.Evacuate if there is severe pain or fever.
54Guidelines for Evacuation of Genitourinary Problems (1 of 2) Evacuate for:Urinary obstruction with inability to urinateUrinary symptoms wit fever, chills, and back painSudden testicular painSwelling, redness, and pain around the shaft of the penis or scrotum
55Guidelines for Evacuation of Genitourinary Problems (2 of 2) No evacuation necessary for:Blood in urineFrequent urination without feverPus discharge from sores on the genitalia