Inflammation of theReproductive Organs

•Vaginitis
•inflammation of the vaginal mucosa & often asso. with irritation or infection of the vulva, usually cause by a change in the normal balance of vaginal bacteria, infection or reduced estrogen levels after menopause.
•Most Common Types of Vaginitis
•Bacterial vaginosis
–vaginitis results from overgrowth of one of several organisms normally present in the vagina, upsetting the natural balance of vaginal bacteria
•Yeast infections
–usually caused by Candida albicans (a naturally occurring fungus)
•Trichomoniasis
–caused by a parasite & is commonly transmitted by sexual intercourse.
•Atrophic vaginitis
–results from reduced estrogen levels after menopause. The vaginal tissues become thinner & drier, which may lead to itching, burning or pain.
•Causes & Forms of Vaginitis
•Infection
–Infectious vaginitis: accounts for 90% of all cases in reproductive age women & is represented by the triad:
–Candidiasis: vaginitis caused by C. albicans (a yeast)
–Trichomoniasis: vaginitis caused by T. vaginalis (a protozoan)
–Bacterial vaginosis: vaginitis caused by Gardnerella (a bacterium).
–Other less common infections are caused by gonorrhea, chlamydia, mycoplasma, herpes, campylobacter & some parasites
•Risk Factors for Vaginal Candida Infections
•Recent Course of Antibiotics
•Uncontrolled Diabetes
•Pregnancy
•High Estrogen Contraceptives
•Immunosuppression
•Thyroid or Endocrine Disorders
•Corticosteroid Therapy
•Causes & Forms of Vaginitis
•Hormonal vaginitis
–Hormonal vaginitis: includes atrophic vaginitis usually found in postmenopausal or postpartum women, sometimes occur in young girls before puberty. In these situations (due to i prodxn of estrogen)
•Irritation/allergy (non infectious vaginitis)
–Irritant vaginitis: caused by allergies to condoms, spermicides, soaps, perfumes, douches, lubricants & semen; can also be caused by hot tubs, abrasion, tissue, tampons or topical medications
•Causes & Forms of Vaginitis
•Foreign body
–Foreign Body Vaginitis: Foreign bodies (most commonly retained tampons or condoms) cause extremely malodorous vaginal discharges. Tx: removal, using ring forceps
•Organisms that are passed between sexual partners.
•Symptoms
•irritation &/or itching of the genital area
•inflammation (irritation, redness, & swelling caused by the presence of extra immune cells) of the labia majora, labia minora, or perineal area
•vaginal discharge
•foul vaginal odor
•discomfort or burning when urinating
•pain/irritation with sexual intercourse
•The color of the discharge may be predictive of the causative agent:
•Candida Vaginitis -Candidiasis - watery, white, cottage cheese like vaginal discharge; irritating to the vagina & the surrounding skin.
•Atrophic vaginitis (or "Senile Vaginitis") – scanty, dry, odorless vaginal discharge, usually causes painful intercourse (due to decreased hormones usually occurring during & after menopause)
•Bacterial Vaginitis - Gardnerella - fish-like odor, associated with itching & irritation
•The color of the discharge may be predictive of the causative agent:
•Trichonomas Vaginitis - profuse discharge with a fish-like odor, usually causes pain upon urination, painful intercourse, & inflammation of the external genitals.
**Women who have diabetes frequently develop vaginitis (often Candida Candida albicans) more often than women who do not.
•Diagnostic Procedures
•PAP smear
–Measurement of vaginal pH
- h w/ infxn
–C/S of vaginal discharge
•Complications
•Premature delivery & low birth wt baby
•persistent discomfort
•superficial skin infection (from scratching)
•complications of the causative condition (such as gonorrhea & candida infection)
•Treatment
•oral or topical antibiotics
•Antifungal/ antibacterial creams
–A cream containing cortisone may also be used to relieve some of the irritation
–a topical estrogen cream - for women who have irritation & inflammation caused by low levels of estrogen (postmenopausal)
•Prevention
Good hygiene may prevent some types of vaginitis from recurring & may relieve some symptoms:
•Avoid baths, hot tubs & whirlpool spas
–Rinse soap from outer genital area after a shower, & dry the area well to prevent irritation. Don't use scented or harsh soaps, such as those with deodorant or antibacterial action.
•Avoid irritants
–These include scented tampons & pads.
•Wipe from front to back after using the toilet
•Prevention
•Other things that may help prevent vaginitis:
–Don't douche :
•vagina doesn't require cleansing other than normal bathing
•Repetitive douching disrupts the normal organisms that live in the vagina & can actually h risk of vaginal infection
•Douching won't clear up a vaginal infection
–Use a male latex condom
–Wear cotton underwear & pantyhose with a cotton crotch: Don't wear underwear to bed. Yeast thrives in moist environments.
–Eat yogurt that contains active lactobacillus cultures.
•Lactobacillus is a type of "good" bacteria that's common in the vagina
•may sometimes help reduce recurrent vag. yeast infxns
•Cervicitis
•an inflammation of the cervix, the lower, narrow end of the uterus that opens into the vagina, caused by infection with STDs, including gonorrhea & chlamydia.
•Signs & Symptoms
•Asymptomatic (most often)
•Vaginal discharge that's grayish or yellow, possibly with an odor
•Frequent, painful urination
•Pain during intercourse
•Vaginal bleeding after intercourse, between menstrual periods or after menopause
•Causes
•Bacteria & viral infxn transmitted thru sexual contact
•Allergic rxn
•Bacterial overgrowth
•Risk Factors
•Engage in high-risk sexual behavior, such as unprotected sex or sex with multiple partners
•Began having sex at an early age
•Have a history of sexually transmitted diseases
•h risk if have sex with a partner who has engaged in high-risk sexual behavior or has had a sexually transmitted
•Diagnostic Procedures
•Pelvic exam
•PAP smear
Complications
•PID
•Treatment
•Antibiotic/ Antiviral
Prevention
•Practice safe sex
•Be monogamous
•Bartholinitis
•Inflammation of Bartholin's gland (bartholinitis) may be induced by Staphylococci, Streptococci, Escherichia coli, & Gonococci which have penetrated into the Bartholin's duct.
•The duct is occluded as a result of tissue edema & the retained secretion of the gland suppurates forming an abscess which not uncommonly ruptures spontaneously.
•The inflammatory process may subside without any suppuration & rupture
•Signs & Symptoms
•Severe pain in the labial area when sitting & walking
•General malaise
•Fever
•Elevated pulse rate
•Edema & hyperaemia in the area of the labia majora
•Suppurative lesions
•Development of a cyst in the labia majora (for recurrent Bartholinitis)
•Management
•Bed rest
•Cold applications (ice bags)
•Administration of antibiotics & sulphanilamides
•Surgery: Marsupialization - if the focus is suppurative
–suturing of the edges of the open cyst wall to the edges of the operative wound
–In cases of the spontaneous opening of an abscess, the involved area is treated with antiseptic solutions (3% solution of hydrogen peroxide) & then dressed with antibiotic ointment.
•Pelvic Inflammatory Disease
•infection of the female repro. organs, usually occurs when sexually transmitted bacteria spread from the vagina to the uterus & upper genital tract.
•may also develop when bacteria travel up a contraceptive device or when bacteria are introduced during gynecologic procedures.
•Pelvic Inflammatory Disease
•Many women who develop PID either experience no s/sx or don't seek tx
•PID may be detected only later when there is a problem getting pregnant or if there is chronic pelvic pain
•PID can result in infertility or complications during pregnancy
–Prompt tx of a STD can help prevent PID
•Signs & Symptoms
•Pain in your lower abdomen & pelvis
•Heavy vaginal discharge with an unpleasant odor
•Irregular menstrual bleeding
•Pain during intercourse
•Low back pain
•Fever, fatigue, diarrhea or vomiting
•Painful or difficult urination
WARNING signs & symptoms of PID:
•Severe pain low in your abdomen
•Vomiting
•Signs of shock, such as fainting
•Fever of higher than 101 F

•Causes
•Unsafe sexual practices - h likelihood of acquiring a STD,
h risk of PID
•Some forms of contraception may affect risk of developing PID
–Contraceptive IUDs may h risk of PID
–Barrier methods, such as condoms or diaphragms, i risk
–Use of the birth control pill alone offers no protection against acquiring STDs. But it may offer some protection against the dev’t of PID by causing the body to create thicker cervical mucus, making it more difficult for bacteria to reach the upper genital tract.
•Bacteria may also enter repro. tract as a result of an IUD insertion, childbirth, miscarriage, abortion or removing a small piece of tissue from uterine lining for lab analysis (endometrial biopsy)
•Risk Factors
•Sexually active woman younger than 25 y/o
•Multiple sexual partners
•Using nonbarrier contraceptives
–consistent use of barrier methods protects against PID, but not against other STDs, such as human papillomavirus (HPV) & herpes simplex virus (HSV)
•Recent IUD insertion
•Regular douching - may flush bacteria higher into the genital tract & mask symptoms that might cause to seek early treatment
•Having a history of PID or any STD

•Screening & Diagnosis
•Analysis of vaginal discharge & cervical cultures
•Pelvic laparoscopy - to confirm the diagnosis or to determine how widespread the infxn
–The doctor inserts a thin, lighted instrument through a small incision in abdomen to view the pelvic organs
•Complications
Abscesses in fallopian tubes & may damage reproductive organs.
•Ectopic pregnancy
–PID is a major cause of tubal (ectopic) pregnancy
•Infertility
–About one in eight women with PID becomes infertile after one year of unprotected sex
–Delay tx for PID h risk of infertility
•Chronic pelvic pain
–may last for mos. or yrs.
–Scarring in fallopian tubes & other pelvic organs can cause pain that commonly occurs during intercourse, exercise & ovulation
•Treatment
•Antibiotics - may prescribe a combination of antibiotics before receiving the results of the lab tests
•Analgesics
•Bed rest
•Avoid sexual intercourse until treatment is completed & tests indicate that the infection has cleared
•Prevention
•Safe sex practices
–Proper use of condoms i, but doesn't eliminate, the risk of contracting an STD
–Monogamous sexual relationships or abstinence
•Regular screenings for STDs
•Advise partner to be tested &, if necessary, be treated if a partner is (+) – to prevent the spread of STDs & possible recurrence of PID.
•Endometriosis
•Presence of endometrial tissue outside the lining of the uterine cavity
•Displaced endometrial tissue generally confined to the pelvic area (usually around the ovaries, uterovesical peritoneum, uterosacral ligaments & cul de sac) but can appear anywhere in the body
•It may occur in any age, including adolescence
•May be present in as many as 50% of infertility women
•Pathophysiology:Endometriosis
•implantation of the endometrium outside the uterus, most commonly on fallopian tubes, ovaries or the tissue lining of the pelvis
i
•Endometrium continues to act in its normal way: It thickens, breaks down & bleeds each month as the hormone levels rise & fall. Because there's nowhere for the blood from this displaced tissue to exit the body, it becomes trapped, & surrounding tissue can become irritated
i
•Trapped blood may lead to the growth of cysts g scar tissue formation & adhesions g pain in the area of misplaced tissue (often the pelvis) especially during menstruation. Scars & adhesions related to endometriosis also can cause fertility problems
•Causes
•Unknown
•Main theories
–Retrograde menstruation with implantation at ectopic sites
–Genetic predisposition & depressed immune system (may predispose to endometriosis)
–Coelomic metaplasia (repeated inflammation inducing metaplasia of mesothelial cells to the endometrial epithelium)
–Lymphatic or hematogenous spread (extraperitonel dse)
–Undifferentiated embryonic peritoneal tissue cells that remain dormant until hormones stimulate their response
•Signs & Symptoms
•Dysmenorrhea
•Abnormal uterine bleeding
•Infertility & profuse menses due to ectopic tissue in the uvaries & oviducts
•Pain that begins 5-7 days before menses peak & lasts for 2-3 days due to implantation of ectopic tissues & adhesions
•Dyspareunia
•Suprapubic pain, dysuria & hematuria due to ectopic tissue in the bladder
•Abdominal cramps, pain on defecation & constipation; bloody stools from bleeding of ectopic endometrium in the rectosigmoid musculature
•Complications
•Infertility
•Chronic pelvic pain
•Ovarian CA (rare)
•Diagnostic Tests
•Laparoscopy or laparotomy – the only definitive diagnostic
•Biopsy
•Empiric trial of GnRH agonist therapy confirms or refutes the impression of endometriosis
•Ultrasound
•Management
•Androgens such as Danazol, to inhibit the anterior PG
•Progestins & continuous combined hormonal contraceptives (pseudopregnancy regimen) to relieve symptoms by causing a regression of endometrial tissue
•GnRH agonists to induce pseudomenopause (medical oophorectomy), causing remission of the dse (commonly used)
•Laparoscopic removal of endometrial implants with conventional or laser
•Presacral neurectomy for central pelvic pain (50% effective)
•Laparoscopic uterosacral nerve ablation
•TAHBSO or TAH
•Analgesics
•Nursing Considerations
•Tell pt undergoing laparoscopy that they may experience pain in the shoulders from gas pumped into the abd. (to separate the organs & prevent accidental puncture) & some discomfort at the laparoscope insertion site
•Advise to avoid undergoing minor gynecological procedures immediately before & during menstruation (this may promote spread of endometrial tissue)
•Advise not to postpone childbearing for those who want to have children
•Recommend an annual pelvic exam & PAP smear
•Inform the pt taking Danazol that ovulation & menstruation will stop, resulting in pseudomenopause (tx lasts from 6-9 mos)
–Advise about expected adverse effects: acne, i breast size, edema. Flushing, sweating, voice deepening & wt. gain
–Inform pt that virilization effects may be irreversible
•Amenorrhea
•Abnormal absence or suppression of menstruation
•Primary amenorrhea: absence of menarche in an adolescent (age 16 & older)
•Secondary amenorrhea: cessation of menstruation for at least 3 mos. after the normal onset of menarche
•Pathophysiology
•In primary amenorrhea, the hypothalamic-pituitary-ovarian axis is dysfunctional:
–Caused by anatomic defects of the CNS
–Results in the ovary’s failure to receive hormonal signals that normally initiate the dev’t of secondary sex characteristics & menarche
•Secondary amenorrhea can result from:
–Hypogonadotropic-hypoestrogenic anovulation
–Uterine factors (as w/ Asherman’s syndrome: endometrium is sufficiently scarred that leads to nonfunctioning of the endometrium)
–Cervical stenosis
–Premature ovarian failure
•Causes
•Autoimmune disease
•Hormonal abnormalities
•Infection (mumps, oophoritis)
•Lack of ovarian response to gonadotropins
•Constant presence of progesterone or other endocrine abnormalities
•Absence of a uterus
•Endometrial damage
•Ovarian, adrenal or pituitary tumors
•Emotional disorders such as anorexia nervosa
•Malnutrition or obesity
•Excessive exercise
•Signs & Symptoms
•Absence of menstruation due to underlying cause
•Vasomotor flushes
•Vaginal atrophy
•Hirsutism
•Acne (secondary amenorrhea)
Complications
•Infertility
•Endometrial adenocarcinoma
•Diagnostic Tests
•Pregnancy test to rule out pregnancy
•Gonadotropin testing: reveals h or i pituitary gonadotropin levels
•Urine testing: h urinary 17-ketosteroids levels & excessive androgen secretion
•Vaginal cytologic examination, endometrial biopsy
•Plasma FSH analysis: level higher than 50 IU/L in primary ovarian failure; normal or low level in possible hypothalamic or pituitary abnormality
•Thyroid function test
•Laparoscopy, hysteroscopy
•CT, MRI
•Ultrasound
•Management
•Appropriate hormone replacement to reestablish menstruation
•Inducing ovulation using Clomiphene citrate (Clomid)
–For women with an intact PG
–May be successful for secondary amenorrhea due to gonadotropin deficiency, polycystic ovarian dse, or excessive wt. loss or gain
•FSH & human menopausal gonadotropins (Pergonal) for pituitary dse
•Improving nutritional status & normalizing wt.
•Modification exercise routine, if needed
•Treatment of emotional disorder, if needed
•Nursing Considerations
•Explain all diagnostic procedures & treatments to the pt
•Provide emotional support; psychiatric counseling if amenorrhea results from emotional disturbances or eating disorders
•After treatment: treat the pt how to keep an accurate record of menstrual cycles to aid in the early detection of recurrent amenorrhea
•Dysmenorrhea
•Painful menstruation associated with ovulation & unrelated to pelvic dse.
•Primary dysmenorrhea or secondary dysmenorrhea
–Primary dysmenorrhea - involves no physical abnormality & usually begins 6 mos-1year after began menstruating
•cramps tend to decrease in intensity as women get older & often disappear after pregnancy
–Secondary dysmenorrhea - involves an underlying physical cause, such as endometriosis or uterine fibroids.
•Pathophysiology
•Pain results from h prostaglandin secretion or sensitivity to prostaglandin in menstrual blood, which intensifies normal uterine contractions
•Prostaglandin intensify myometrial smooth muscle contraction & uterine bld vessel constriction thereby worsening the uterine hypoxia normally associated with menstruation
•A combination of intense muscle contractions & hypoxia causes the intense pain of dysmenorrhea
•Causes
•Primary dysmenorrhea
–Possible contributing factors:
•Hormonal imbalance
•Psychogenic factors such as depression
•Secondary dysmenorrhea
–Endometriosis
–Adenomyosis – tissue lining of the uterus begins to grow w/in the muscle walls of the uterus
–Cervical stenosis
–PID
–Pelvic tumors
–Use of IUD – may cause increased cramping during the 1st few months after insertion
–Uterine fibroids (leiomyoma) & uterine polyps (noncancerous) protrude from the lining of the uterus
•Signs & Symptoms
•Sharp, intermittent, cramping or throbbing pain in lower abdomen radiating to the lower back & thighs immediately w/ or before menstrual flow & peaks w/in 24 hrs
•Other signs & symptoms that can occur along with menstrual cramps include:
–Nausea and vomiting
–Loose stools
–Sweating
–Dizziness/ headache
–Painful breasts
–Irritability, depression
–Abdominal bloating
–Frequent urination
•Complications
•Primary dysmenorrhea
–Dehydration
•Secondary dysmenorrhea depend on the underlying cause:
–PID can cause scarring of the fallopian tubes that can lead to an ectopic pregnancy
–Endometriosis can lead to impaired fertility
Diagnostic Tests
•Pelvic exam
•Laparoscopy, hysteroscopy, or pelvic UTZ
•CT scan, MRI
•Management
•Nonsteroidal anti-inflammatory drug (NSAID), such as aspirin, ibuprofen (Advil, Motrin, etc.) or naproxen (Aleve)
•Ca to prevent & ameliorate uterine muscle spasms
•Apply hot compress on the lower abdomen to relieve discomfort
•Exercise (may i prostaglandin production by reducing endometrial hyperplasia)
•Primary dysmenorrhea
–Low-dose oral contraceptives to prevent ovulation, w/c may i the production of prostaglandins & i the severity of cramps
•Secondary dysmenorrhea: treat the underlying cause
–Antibiotics to treat infection or surgery to remove fibroids or polyps or to treat endometriosis
•Nursing Considerations
•Obtain a complete history, focusing on pt’s gynecological complaints
•Provide thorough pt teaching including normal female ana-physio as well as the nature of dysmenorrhea
•Encourage the pt to keep a detailed record of menstrual cycle & symptoms & to seek medical care if symptoms persist
•Encourage the pt to start a regular fitness program; stimulates endorphin release, helping to relieve discomfort
•Advise dietary modifications & vitamin therapy
–h dietary intake of whole grains & green, leafy vegetables
–i intake of caffeine, chocolate, alcohol, saturated fats & refined sugar products
–h intake of omega-3 polyunsaturated fatty acids, magnesium, Ca & B vitamins (help to i uterine spasms & cramping)
•Menorrhagia
•excessive or prolonged menstrual bleeding; losing 80 mL or more of blood during menstrual cycle
•Signs & Symptoms
•Menstrual flow that soaks through one or more sanitary pads every hour for several consecutive hours
•Menstrual periods last longer than 7 days
•Presence of large blood clots in menstrual flow
•Constant pain in lower abdomen during periods
•Tiredness, fatigue or shortness of breath (symptoms of anemia)
•Causes
•Hormonal imbalance
•Uterine fibroids
•Polyps
•Dysfunction of the ovaries - Lack of ovulation (anovulation) may cause hormonal imbalance & result in menorrhagia
•Adenomyosis (tissue lining of the uterus begins to grow w/in the muscle walls of the uterus)
•Intrauterine device (IUD)
•Pregnancy complications
–An ectopic pregnancy — may cause menorrhagia
•Cancer
•Medications: anti-inflammatory medications & anticoagulants can contribute to heavy or prolonged menstrual bleeding
•Other medical conditions: PID, thyroid problems, endometriosis, liver or kidney disease
•Diagnostic Tests
•Blood tests
–CBC – to check for blood loss
–Blood test for thyroid disorders or blood-clotting abnormalities
•Pap test
•Endometrial biopsy
•Ultrasound scan
•Sonohysterogram - This ultrasound scan is done after fluid is injected through a tube into the uterus via vagina & cervix. This allows the doctor to look for problems in the lining of the uterus.
•Hysteroscopy - A tiny tube with a light is inserted through vagina & cervix into the uterus
•Dilation & curettage (D and C) - to collect tissue from the uterine lining
•Complications
•Anemia
•Severe pain - requires prescription medication or a surgical procedure
•Management
•Drug therapy for menorrhagia may include:
–Iron supplements
–Nonsteroidal anti-inflammatory drugs (NSAIDs)
–Oral contraceptives - can help regulate ovulation & i episodes of excessive or prolonged menstrual bleeding.
•Progesterone - can help correct hormonal imbalance and reduce menorrhagia.
•Dilation & curettage (D & C), if drug tx is not successful
•Operative hysteroscopy - surgical removal of a polyp that may be causing excessive menstrual bleeding
•Management
•Endometrial ablation - permanently destroys the entire lining of the uterus.
–After endometrial ablation, most women have normal menstrual flow, some have little or no menstrual flow.
–Endometrial ablation reduces the ability to become pregnant.
•Endometrial resection
–This surgical procedure uses an electrosurgical wire loop to remove the lining of the uterus.
•Hysterectomy
–Surgical removal of the uterus & cervix
•Premenstrual Syndrome
•a tricky condition of a wide variety of signs & symptoms before the onset of menstrual period
•These problems are more likely to trouble women between their late 20s & early 40s, and they tend to recur in a predictable pattern.
•Signs & Symptoms
•Emotional & behavioral symptoms
–Tension or anxiety
–Depressed mood
–Crying spells
–Mood swings and irritability or anger
–Appetite changes and food cravings
–Trouble falling asleep (insomnia)
–Social withdrawal
–Poor concentration
•Physical signs and symptoms
–Joint or muscle pain
–Headache
–Fatigue
–Weight gain from fluid retention
–Abdominal bloating
–Breast tenderness
–Acne flare-ups
–Constipation or diarrhea
•Signs & Symptoms
•For most of these women, signs & symptoms disappear as the menstrual period begins.
•Premenstrual dysphoric disorder (PMDD) – a severe form of premenstrual syndrome with symptoms including:
–severe depression
–feelings of hopelessness
–Anger
–Anxiety
–low self-esteem
–difficulty concentrating
–Irritability & tension
**A number of women with severe PMS may have an underlying psychiatric disorder.
•Causes
•Unknown cause
•Contributing Factors:
–Cyclic changes in hormones
–Chemical changes in the brain - Fluctuations of serotonin, a brain chemical (neurotransmitter), play a crucial role in mood states could trigger the symptoms. Insufficient amounts of serotonin may contribute to premenstrual depression, fatigue, food cravings & sleep problems.
•Stress, depression
•Low levels of vitamins & minerals
•Eating a lot of salty foods (may cause fluid retention) & drinking alcohol & caffeinated beverages (may cause mood & energy level disturbances)
•Management
•Antidepressants
–use of antidepressants may be limited to the two weeks before menstruation begins.
•Nonsteroidal anti-inflammatory drugs (NSAIDs)
–Taken before or at the onset of mens. Period
•Diuretics
–to reduce the weight gain, swelling & bloating
–Spironolactone - a diuretic that can help ease some of the symptoms of PMS.
•Oral contraceptives
–To stop ovulation & stabilize hormonal swings
•Medroxyprogesterone acetate (Depo-Provera)
–It is used to temporarily stop ovulation. However, Depo-Provera may cause an increase in some s/sx of PMS, such as increased appetite, weight gain, headache & depressed mood.
•Management
•Modify your diet
•Eat smaller, more frequent meals each day to reduce bloating & the sensation of fullness.
•Limit salt & salty foods to reduce bloating & fluid retention
•Choose foods high in complex carbohydrates, such as fruits, vegetables & whole grains.
•Ca-rich foods or calcium supplement.
•Daily multivitamin supplement.
•Avoid caffeine & alcohol.
•Incorporate exercise into regular routine
•Reduce stress
–Get plenty of sleep.
–Muscle relaxation or deep-breathing exercises to help i headaches, anxiety or insomnia
–Yoga or massage - to relax & relieve stress
•Record symptoms for a few months
–to identify the triggers & timing of symptoms – to develop strategies that may help to lessen them.
•Uterine Prolapse
•Stages of uterine prolapse are described by the degree of descent of the uterus.
•Dyspareunia, backache, pressure in the pelvis, bowel or bladder problems
•Pessaries (an appliance inserted into the vagina, usually as an aid toward maintaining the normal positions of the uterus and bladder)
•Surgery
•Cystocele
•Protrusion of the bladder through the vaginal wall due to weakened pelvic structures
•Difficulty in emptying bladder, urinary frequency and urgency, urinary tract infection, stress urinary incontinence
•Kegel exercises
•Surgery
•Rectocele
•Protrusion of the rectum through a weakened vaginal wall
•Constipation, hemorrhoids, fecal impaction, feelings of rectal or vaginal fullness
•High-fiber diet, stool softeners, laxatives
•Surgery
•Male Reproductive Disorders
•Congenital Disorders
•Hypospadia
–A birth deformity in which the urethra ends before it reaches the tip of the penis.
•Cryptorchidism
–Congenital disorder in w/c one or both testes fail to descend into the scrotum, remaining in the abdomen or inguinal canal or at the external ring of the inguinal canal
–Most commonly affects the right testis, although it may be bilateral
–True undescended testes – testes remain along the path of normal descent
–Ectopic testes – testes deviate from the path of normal descent
•Pathophysiology
•A prevalent but still unsubstantiated theory links undescended testes to dev’t of the gubernaculum (a fibromuscular band that connects the testes to the scrotal floor)
•It may result from inadequate testosterone levels or a defect in the testes or the gubernaculum
•Because the testes are maintained at a higher temp. by being w/in the body, spermatogenesis is impaired, leading to reduced fertility
•Causes
•Hormonal factors (testosterone deficiency)
•Structural factors
•Genetic predisposition
•Prematurity (premature neonates are most commonly affected bec.testes normally descend into the scrotum around 28 wks’ gestation)
•Prenatal exposure to diethylstillbestrol
•Signs & Symptoms
•Nonpalpable testis on affected side
•Enlarged scrotum on the affected side due to compensatory hypertrophy (occasionally)
•Infertility after puberty due to absence of spermatogenesis (uncorrectedbilateral cryptorchidism) despite normal testosterone levels
•Complications
•Sterility
•Risk of testicular CA
•Increased vulnerability to trauma if bilateral cryptorchidism isn’t treated by early adolescence
•Diagnostic Tests
•Surgical: Orchiopexy
–Indicated if the testes don’t descend spontaneously by age 1
–Usually performed before age 4; optimum age is 1-2 yrs bec. about 40% of undescended testes can no longer produce viale sperm by age 2
•Human chorionic gonadotropin (hCG) – to stimulate descent (rarely used); ineffective for testes located in the abdomen
•Nursing Considerations
•Provide info. on causes, available treatments & possible effect on reproduction; emphasize that the testes may descend spontaneously (esp. in premature infants)
•Prepare the child for surgery using age-appropriate explanations & terms the child understands
–Tell the child that a rubber band may be taped to his thigh for about 1 week after surgery to keep the testis in place
–Explain that his scrotum may swell but shouldn’t be painful
–Reassure the child that he won’t feel pain during surgery
•Nursing Considerations
•Provide appropriate care after orchiopexy
–Monitor VS, I & O, check dressings, encourage deep breathing & coughing & watch out for urine retention
–Keep the operative site clean, & teach the child to wipe from front to back after defecation
–Maintain tension on the applied rubber band to keep the testis in place & make sure that it isn’t too tight
–Encourage parent to participate in post-op care, such as bathing, feeding the child; urge the child to do as much for himself as possible (age-appropriate
•Orchitis (Mumps)
•Acute testicular inflammation resulting from trauma or infection
•Treatment: bedrest with scrotal elevation, application of ice, and administration of analgesics and antibiotics
•Mumps orchitis
•Hydrocele
•Cystic mass is usually filled with straw-colored fluid that forms around the testis resulting from impaired lymphatic drainage of the scrotum, causing a swelling of the tissue surrounding the testes.
•Hydrocele may be drained via needle and syringe or it may be removed surgically.
•Spermatocele
•A sperm-containing cyst develops on the epididymis alongside the testicle.
•Normally, spermatoceles are small and asymptomatic, and require no interventions.
•If they become large enough to cause discomfort, a spermatocelectomy is performed.
•Epididymitis
•Inflammation of the epididymis resulting from an infection or noninfectious source such as trauma
•Treatment: bedrest with scrotum elevated on a towel, scrotal support when ambulating
•Comfort measures
•Epididymectomy
•Varicocele
•A cluster of dilated veins occur behind and above the testis.
•Varicoceles can also cause infertility.
•Varicocelectomy is performed through an inguinal incision in which the spermatic veins are ligated in the cord.
•Phimosis & Paraphimosis
•Phimosis- constricted prepuce that cannot be retracted over the glans
•Paraphimosis- prepuce remains down around the tip of the penis
•Emergency requiring immediate tx
•Circumcision
•Warm bath to allow dressing to loosen
•Barbiturate sleeping medications
•Priapism
•Uncontrolled and long-maintained erection without sexual desire; causes the penis to become large and painful
•Can occur from:
–Thrombosis of veins of corpora cavernosa
–Leukemia
–Sickle cell disease
–Diabetes mellitus
–Malignancies
–Abnormal reflex
–Some drug effects
–Recreational drugs
–Prolonged sexual activity
•Collaborative Management
•Urologic emergency
•Goal of intervention: to improve the venous drainage of the corpora cavernosa
•Meperidine
•Warm enemas
•Urinary or suprapubic catheterization
•Large-bore needle or Sx intervention
•Bacterial Prostatitis
•Often occurs with urethritis or an infection of the lower urinary tract
•Fever, chills, dysuria, urethral discharge, and boggy, tender prostate
•Urethral discharge with white blood cells in the prostatic secretions
•Chronic bacterial prostatitis
•Nonbacterial/Chronic Pelvic Pain Syndrome
•Can occur after viral illness or may be associated with sexually transmitted diseases
•Other causes: autoimmune, neuromuscular etiologies, allergy-mediated reactions, psychosexual problems
•Prostatodynia or pelvic floor pain
•Treatment
•Benign Prostatic Hyperplasia
•Enlargement of the prostate sufficient to compress the urethra & cause urinary obstruction
Causes
•Aging
•Arteriosclerosis
•Inflammation
•Metabolic or nutritional disturbances
•Family history
•Clinical Manifestations
•Due to enlarged prostate gland:
–Reduced urinary stream
–Urinary hesitancy
–Difficulty starting micturition
•Due to increased obstruction:
–Nocturia
–Polyuria
–Urine retention & incontinence
–Possible hematuria
•Visible midline mass due to incompletely emptied bladder
COMPLICATIONS
•Complete urinary obstruction
•Infection
•Hydronephrosis
•Renal insufficiency
•Renal failure
•Renal calculi
•Hemorrhage
•Shock
•Diagnostic Test
•Digital rectal exam
•Prostate specific antigen: slightly elevated
•Cystourethroscopy
•Transrectal ultrasound
•Management
•Even spacing of fluid intake throughout the day to prevent bladder distention
•Limit nighttime fluid to prevent nocturia
•Antibiotics to treat UTI
•Alpha-adrenergic blockers (terazosin, doxazosin, tamsulosin, to improve urine flow rates and relieve bladder outlet obstruction by relaxing the smooth muscle of the prostate and bladder neck
•Administer Finasteride (Proscar) or Dutasteride (Avodart) to reduce prostate size
•Insert Indwelling catheter to alleviate urine retention
•Alternative Treatment for Mild Symptoms
•Gentle prostate massage to decrease prostatic congestion
•Cold Sitz bath for 3-8 minutes to stimulate blood flow to the prostate and bladder
•Regular ejaculation to help relieve prostatic congestion
•Surgical Management
•Transurethral resection of the prostate (TURP)
•Transurethral needle ablation (TUNA) to burn away well-defined regions of the prostate to improve urine flow
•Transurethral microwave treatment to destroy portions of the prostate w/ heat
•Transurethral laser excision to reduce prostate size
•Open surgery:
–Suprapubic (transvesical) resection: most common; useful for prostatic enlargement causing pouching w/in the gallbladder
–Retropubic (extravesical) resection: allows direct visualization; potency & continence are usually maintained
•Nursing Considerations
•Monitor VS, I & O & daily weigh
•Monitor for signs of post operative diuresis that may lead to serious dehydration, reduced blood volume, electrolyte loss, shock & anuria
•Maintain patent catheter
•Provide appropriate post operative care