1. Assessment of the Female Reproductive System

2. Female Reproductive System
External genitalia: vulva, labia majora, labia minora, clitoris, vestibule, perineum
Internal genitalia: vagina, uterus, corpus, cervix, fallopian tubes, ovaries
Breasts
Menstruation and menopause

4. Assessment Techniques: Female
History: pain, bleeding, discharge, masses
Physical assessment
Breast examination
Abdominal examination
Examination of the external genitalia
Pelvic examination
Bimanual examination
Rectovaginal examination

5. Papanicolaou Test Client preparation for pap test Procedure
Follow-up care

6. Blood Studies Pituitary gonadotropin Steroid hormones Serologic tests
Syphilis detection
Prostate-specific antigen

7. Other Studies Urinalysis for steroid hormones Wet preparation (smears)
Cultures
General x-rays
CT scans for reproductive system disorders
(Continued)
S&P

8. Other Studies (Continued)
Hysterosalpingography: an x-ray of the cervix, uterus, and fallopian tubes Mammography
Ultrasonography
Magnetic resonance imaging to scan for pelvic tumors
Colposcopy
Laparoscopy
Hysteroscopy
Cervical biopsy
Endometrial biopsy and aspiration

9. Other Diagnostic Tests
Needle biopsy of the prostate
Semen analysis

10. Interventions for Clients with Gynecologic Problems

11. Primary Dysmenorrhea
One of the most common gynecologic problems, occurring most often in women in their teens and early 20s.
Treatment
Postaglandin synthetase inhibitors, oral contraceptives
Complementary and alternative therapy
S&P

12. Premenstrual Syndrome
A collection of symptoms that are cyclic in nature
Diet therapy
Drug therapy: mild potassium-sparing diuretics, progesterone, bromocriptine mesylate, Sarafem

13. Amenorrhea Absence of menstrual periods Primary amenorrhea
Secondary amenorrhea
Treatment: hormone replacement, ovulation stimulation, periodic progesterone withdrawal

14. Postmenopausal Bleeding
Manifestation (not disease)—vaginal bleeding that occurs after a 12-month cessation of menses after the onset of menopause
Atrophic vaginitis
Endometrial hyperplasia
Treatment: endometrial biopsy, hysterectomy, hormonal replacement therapy, vaginal lubricants
S&P

15. Endometriosis
Endometriosis is usually a benign problem of endometrial tissue implantation outside the uterine cavity.
Manifestations include pain, dyspareunia, painful defecation, sacral backache, hypermenorrhea, and infertility.
Erythrocyte sedimentation rate and white blood cell count rule out pelvic inflammatory disease.
Laparoscopy is the key diagnostic procedure.
S&P

16. Endometriosis: Interventions
Drug therapy
Mild analgesics, nonsteroidal anti-inflammatory drugs, hormonal therapies, pseudopregnancy, pseudomenopause, or medical oophorectomy
Complementary and alternative therapy
Surgical management

17. Dysfunctional Uterine Bleeding
Nonspecific term to describe bleeding that is excessive or abnormal in amount or frequency without predisposing anatomic or systemic conditions
Associated with:
Endocrine disturbances
Polycystic ovary disease
Stress
Extreme weight changes
Long-term drug use
Anatomic abnormalities
Management
Nonsurgical management includes hormone manipulation.
Surgical management includes:
Dilation and curettage procedure
Laser or balloon endometrial ablation
Hysterectomy

18. Menopause
Normal biologic event marked for most women by the end of menstrual periods (6 to 12 months of amenorrhea)
Role of hormone replacement therapy in the management of symptoms
Perimenopause indicated by changes in ovarian function
Interventions, including hormone replacement therapy

19. Simple Vaginitis Inflammation of the lower genital tract
Result of one or more of the following:
Menopause
Trichomonas vaginalis
Candida albicans
Changes in normal flora
Alkaline pH
Foreign bodies
Chemical irritants
Diabetes

20. Management of Vaginitis
Perineal cleaning after urination or defecation
Wearing cotton underwear
Avoiding strong douches and feminine hygiene sprays
Avoiding tight-fitting pants
Using estrogen creams
Eating yogurt with antibiotics
S&P

21. Vulvitis
Inflammatory condition of the vulva (itching) associated with symptoms of pruritus and a burning sensation
Other causes include the following:
Atrophic vaginitis
Vulvar kraurosis
Vulvar leukoplakia
Cancer
Urinary incontinence

22. Management of Vulvitis
Measures to relieve itching, including sitz baths
Prescribed antibiotics
Treatment of pediculosis and scabies, if needed
Laser therapy

23. Toxic Shock Syndrome (TSS)
First recognized in 1980 when it was found to be related to menstruation and tampon use
Staphylococcus aureus
Abrupt onset of high temperature, headache, sore throat, vomiting, diarrhea, generalized rash, hypotension
Penicillin or vancomycin
S&P

24. Follicular Cysts
Cyst—usually small and may be asymptomatic unless it ruptures
Rupture of a follicular cyst or torsion—may cause acute, severe pelvic pain
Medical management
Surgical management includes:
Cystectomy
Oophorectomy
S&P

25. Corpus Luteum Cyst
Occurs after ovulation and often with increased secretion of progesterone; usually small, purplish red
May cause unilateral low abdominal or pelvic pain that is dull or aching
Intraperitoneal hemorrhage possible if cyst ruptures
S&P

26. Theca-Luatein Cysts
These cysts are uncommon, often associated with hydatidiform molar pregnancy.
Cysts develop as a result of prolonged stimulation of the ovaries by excessive amounts of hCG.
Cysts regress spontaneously within 3 months with the removal of the molar pregnancy.
S&P

27. Polycystic Ovary
High levels of luteinizing hormone overstimulate the ovaries, producing multiple cysts on one or both ovaries.
Endometrial hyperplasia or even carcinoma may result.
Typical client is obese, hirsute, has irregular menses, and may be infertile.
Treatment is with oral contraceptives, surgery, or clomiphene.
S&P

28. Other Benign Ovarian Cysts and Tumors
Dermoid cysts
Ovarian fibromas
Epithelial ovarian tumors
Uterine leiomyomas