Chapter 91 Female Reproductive Disorders

Gynecology Gynecology Focuses on the female reproductive system Gynecologists Obstetrician-gynecologists (OB/GYN)

Pelvic Examination To visualize the cervix, vagina, and perineum Cervical biopsy Cauterization, removal, or coagulation of a portion of the cervix using electricity or laser

Laboratory Tests Pap (Papanicolaou) test or Pap smear Cervical cancer Tests for endometrial cancer Blood tests

Question Is the following statement true or false? Women who have had a hysterectomy and who still have a cervix are not at risk for cervical cancer and do not need to have Pap tests.

Answer False All women with a cervix are at risk for cervical cancer, even women who have had a hysterectomy but who still have a cervix are at risk for cervical cancer and need to have Pap tests. Some women have a higher than normal chance of contracting cervical cancer and require regular screening. Pap tests should be done between a woman’s menstrual periods, as tests are less accurate when a woman is menstruating.

Breast Examination Mammography Breast ultrasound Breast biopsy Aspiration Needle biopsy Excisional biopsy Incisional biopsy

Other Diagnostic Tests Abdominal or pelvic ultrasonography X-ray examinations Laparoscopy Culdoscopy Colposcopy Cervical biopsy Conization (cone biopsy) Cerclage

Question Is the following statement true or false? Following a laparoscopy, a client may feel severe pain under a clavicle.

Answer True Following a laparoscopy, severe pain, such as “shoulder strap pain,” may be felt as pain under a clavicle. This type of referred pain may result from either gas instilled during the procedure, which is temporarily trapped under the diaphragm, or from blood accumulating under the diaphragm.

Common Surgical Treatments Dilation and curettage (D&C) Hysterectomy and pelvic exenteration Vaginal hysterectomy Abdominal hysterectomy Cosmetic breast surgery Augmentation mammoplasty Reduction mammoplasty Mastectomy

Nursing Process Data collection Planning and implementation Teaching feminine hygiene and breast self- examination Providing perineal care and sitz baths Performing a douche or vaginal irrigation Inserting a vaginal suppository Evaluation

Disorders Related to the Menstrual Cycle Amenorrhea Menorrhagia, metrorrhagia Dysmenorrhea Extreme irregularity Premenstrual syndrome (PMS) Premenstrual dysphoric disorder (PMDD) Toxic shock syndrome Discomforts of menopause Induced menopause

Structural Disorders Vaginal fistula Ureterovaginal, vesicovaginal, rectovaginal Cystocele Rectocele Prolapsed uterus Dyspareunia Abnormal flexion of the uterus

Inflammatory Disorders Vulvitis Vaginitis Atrophic (senile) vaginitis Cervicitis Endometriosis Pelvic inflammatory disease (PID) Vulvodynia

Question Is the following statement true or false? If a pregnant woman contracts trichomoniasis, treatment is postponed until after she has delivered her baby.

Answer False If a pregnant woman contracts trichomoniasis, treatment is necessary, although it can be postponed until the second or third trimester because of the unknown effects of the drug on the developing fetus. Untreated trichomoniasis can lead to a fragile cervix that will be unable to maintain pregnancy or withstand delivery.

Trauma Battering, automobile accidents, or falls Rape Vaginal, cervical, or anal bruising or tearing Tampon impaction STIs Injuries are diagnosed and treated symptomatically.

Neoplasms Tumors of the ovary Benign ovarian tumors Malignant ovarian tumors Tumors of the uterus Benign uterine tumors Cancer of the fundus or endometrium

Neoplasms (cont’d) Cancer of the cervix Signs and symptoms Staging of cervical cancer Treatment Cervical cancer in the pregnant woman Caring for the woman undergoing a hysterectomy Preoperative considerations Postoperative nursing considerations

Neoplasms (cont’d) Risk factors for developing cervical cancer Infection with human papillomavirus (HPV) Sexual activity at a young age, frequent sexual activity, multiple sex partners Presence of genital warts (condyloma) or herpes virus II Maternal history of cancer, especially cervical cancer Maternal use of diethylstilbestrol (DES) during pregnancy with this daughter

Breast Neoplasms Benign neoplasms Chronic cystic mastitis Breast cancer

Breast Neoplasms (cont’d) Risk factors for breast cancer Menarche prior to age 12, late menopause, long or irregular menstrual cycles, or women older than 40 Family history of breast cancer, fibrocystic breast disease, cancer of the other breast, endometrial or ovarian cancer Radiation exposure, previous breast surgery, or estrogen replacement therapy >8 years

Breast Neoplasms (cont’d) Risk factors for breast cancer (cont’d) Women who have never had a baby, had their first baby after age 30, have not breastfed, or on antihypertensive therapy Diet high in fat, obesity, alcohol, or tobacco use

Question Is the following statement true or false? A nurse should encourage female clients to get a regular mammogram as well as conduct breast self- examinations.

Answer True According to research, some breast cancers may exist for as long as 6 years before they are detected by palpation. Thus, regular mammography, in conjunction with breast self-examination and annual clinical breast examination by a healthcare provider, are recommended for every woman older than 40 years.

End of Presentation