1. Common Female Complaints
The 3 Ps
Dana Davenport, APRN, MSN, FNP-C
Family Nurse Practitioner

2. Objectives Upon completion of this lecture, the nurse will be able to:
1. Discuss common problems woman have effecting their menstrual cycle.
2. Identify common causes of gynecological pain.
3. Discuss recommended treatment for common STDs.
4. Discuss options for preventing pregnancy.
5. Discuss updates related to prevention of cervical cancer.

3. The 3 P’s Periods Pain Prevention
Women seeking care for gynecological needs often present with a complaint associated with their period, a complaint of pain or seeking prevention of pregnancy or cervical cancer.

4. Periods Amenorrhea Irregular periods Dysfunctional Uterine Bleeding
Dysmenorrhea

5. Amenorrhea Causes Diagnosis Pregnancy Infection PCOS Thyroid
Stress, exercise, eating disorder
Anatomical, hormonal, Tumor
Diagnosis
Complete history
Pregnancy test
Labs: TSH, Prolactin, FSH, LH, Testosterone
Page 453 in Williams
(Beckmann, et al., 2014)
(Hoffman, Schorge, Schaffer, Halvorson, Bradshaw, & Cunningham, 2012)

6. Irregular Periods Causes Diagnosis Infection PCOS Thyroid
Stress, exercise, eating disorder
Tumor
Diagnosis
Obtain complete history
Labs: TSH, Prolactin, FSH, LH, Testosterone
(Beckmann, et al., 2014)
(Hoffman, Schorge, Schaffer, Halvorson, Bradshaw, & Cunningham, 2012)

7. (Cervical polyps, 2017)
(Fibroids, 2015)
(Polyps)

8. Treatment Pregnancy – refer for OB care. Lifestyle changes Medication
Treatment of infection
PCOS treatment options
Lifestyle changes
Medication
Referral to OBGYN or other surgeon.
(Kaunitz, Approach to abnormal uterine bleeding in nonpregnant reproductive-age women, 2016)

9. Dysfunctional Uterine Bleeding
Causes
Ovulatory dysfunction
Polyp
Leiomyoma
Malignancy
Diagnosis
Labs: CBC,
Sonography
Treatment
Medication
Surgery
Remember to watch for anemia.
(The American College of Obstetrics and Gynecologists, 2013)

10. Dysmenorrhea Primary Symptoms Treatments Cramping Nausea Vomiting
Low back pain
Headaches
Diarrhea
Treatments
NSAIDs
OCPs
Diet changes
Pain associated with menstruation
(Hoffman, Schorge, Schaffer, Halvorson, Bradshaw, & Cunningham, 2012)

11. Types of Gynecological Pain
Lower abdominal pain
Ovarian Pain
Pelvic Pain
Dyspareunia

12. Causes of pain Gynecological Urological Gastrointestinal UTI Cystitis
Infection
Ectopic Pregnancy
Ovarian cysts
Endometriosis
Leiomyomas
Urological
UTI
Cystitis
Urinary tract stone
Gastrointestinal
Irritable bowel syndrome
Constipation
Colitis
Diverticular disease
(Hoffman, Schorge, Schaffer, Halvorson, Bradshaw, & Cunningham, 2012)

13. Case Study
A 17 year old female presents complaining of dysuria for about one week. Denies increased frequency, odor, hematuria.
Patient also denies being sexually active, vaginal discharge or abnormal periods.

14. Cause of Pain Diagnose Obtain History Physical exam Labs Radiology
Sexual history
Physical exam
Labs
Radiology
Laparoscopy

15. Treatment of Pain Treatment of infection Referral to Pain control
PCOS treatment options
Physical Therapy
Referral to ER
OBGYN
Urologist
Gastroenterologist
(Barbieri, 2016)
(Kaunitz, Approach to abnormal uterine bleeding in nonpregnant reproductive-age women, 2016)

16. Sexually Transmitted Infections
Bacterial Vaginosis
Chlamydia
Gonorrhea
Herpes
HPV
Syphilis
Trichomoniasis

17. STD Treatment
(STD Tx guide , 2015)

18. Bacterial Vaginosis Signs and symptoms Diagnose Treatment Discharge
Itching
odor
Diagnose
exam
Wet prep
Clue cells
pH of >4.5
Treatment
Metronidazole 500 mg po bid for 7 days OR
Metronidazole gel 0.75%, one applicator full intravaginally, once a day for 5 days
Clindamycin cream 2%, one applicator full intravaginally at bedtime for 7 days
Will discuss risk factors for getting BV.
(Beckmann, et al., 2014)
(Center for Disease Control and Prevention, 2010)

19. Chlamydia Treatment Diagnosis Signs and symptoms Asymptomatic
Discharge
Vaginal bleeding
Dysuria
Diagnosis
Swab
Urine test
Treatment
Azithromycin 1 g po OR
Doxycycline 100 mg po bid for 7 days
(Center for Disease Control and Prevention, 2010)
(Hoffman, Schorge, Schaffer, Halvorson, Bradshaw, & Cunningham, 2012)

20. Gonorrhea Treatment Diagnosis Signs and symptoms Asymptomatic
Discharge-yellow or green
Vaginal bleeding
Dysuria
Diagnosis
Swab
Urine test
Treatment
Ceftriaxone 250 mg IM in a single dose
Plus
Azithromycin 1 g po in a single dose
When treating for gonorrhea it is also recommended to treat for Chlamydia, due to the fact that it is hard to diagnose Chlamydia in the presence of gonorrhea and the high likelihood of having both types of infection.
(Beckmann, et al., 2014)
(Beckmann, et al., 2014)
(Center for Disease Control and Prevention, 2010)

21. Trichomoniasis Treatment Diagnosis Alternative Signs and symptoms
Vulvar itching/burning
Discharge- copious
odor
Dysuria
dyspareunia
Diagnosis
Wet prep
Urine test
Treatment
Metronidazole 2 g po in a single dose
Tinidazole 2 g po in a single dose
Alternative
Metrondazole 500 mg po bid for 7 days.
(Beckmann, et al., 2014)
(Center for Disease Control and Prevention, 2010)

22. Prevention Surgical LARCs Injection Pills/Patch/Ring
Barrier/Spermicide
Withdrawal
Fertility awareness
(Effectiveness of family planning methods, 2011)

23. U.S. Medical Eligibility Criteria for Contraceptive Use
(Curtis, et al., 2016)

24. Deciding what contraception is best?
1. What are your contraceptive goals?
2. Do you have any healthcare problems?
3. What are your periods like?
4. Are you currently sexually active with male partner?
5. What have you tried in the past?
6. Are you good at taking pills?
7. Is price an important factor?
8. Do you also need protection from STIs?
(Kaunitz, Contraceptive counseling and selection, 2016)

25. Surgical Men Women Who should use this Vasectomy
Tubal ligation
Essure
Hysterectomy
Who should use this
Men and women who do not want to conceive.
(Braaten & Dutton, 2016)

26. LARCs IUD Implant Who should use this Copper Mirena – 5 years
Skyla – 3 years
Implant
Nexplanon
Who should use this
Women who are wanting to wait 3-5 years to have a child.
Adolescents
People who say “I can’t remember to take a pill.”
Discuss Pros and Cons of each method.
MEC eligibility chart
(Kaunitz, Contraceptive counseling and selection, 2016)

27. Injection Depo-Provera Who should use this medroxyprogesterone acetate
Every 3 months
Who should use this
Women who do not want to conceive in the near future
HTN
Adolescents
(Kaunitz, Contraceptive counseling and selection, 2016)

28. Oral Contraceptive Pills
Monophasic
Biphasic
Triphasic
Progestin-only
Who should use OCPs
Women who can remember to take a pill daily.
Women who like regular cycles
Women with PCOS
Women who want to conceive in the near future
(Kaunitz, Contraceptive counseling and selection, 2016)

29. Patch/Ring Patch Ring Who should use Patch/Ring
Women who are comfortable with method.
Women who like regular cycles
Women who want to conceive in the near future
(Kaunitz, Contraceptive counseling and selection, 2016)

30. Barrier/Other Condoms Sponge Cervical cap Diaphragm Calendar method
Male
Female
Sponge
Cervical cap
Diaphragm
Calendar method
Who should use this method?
Women who can’t or do not want to use hormonal contraception
Women who also want STI protection
(Kaunitz, Contraceptive counseling and selection, 2016)

31. Cervical Cancer Prevention
HPV vaccine
Pap test
(The dreaded pap test: Opening up (literally) about my experiences, 2013)

32. HPV infection HPV risk factors Detection What is Human papillomavirus?
HPV and Cancer risks
Cervical cancer
Head and neck cancer
Anal cancer
Penile cancer
HPV risk factors
Unprotected sexual contact
Number of sexual partners
Age
Weakened immune system
Damaged skin
Personal contact
Detection
(Mayo Clinic Staff, 2017)
(Palefsky & Cranston, 2015)

33. HPV Vaccinations Recommendations updated in 2016
Boys and girls ages 9-14 receive 2 doses.
1st dose
2 dose 6-12 months after first dose
Boys and girls ages receive 3 doses.
2nd dose- 1-2 months after first dose
3rd dose – 6 months after first dose
(Meites, Kempe, & Markowitz, 2016)

34. Pap test Current guidelines No screening under age of 21 years
Women pap screening every 3 years
30-65 years screening pap with HPV
Over 65 years with adequate testing no screening
(Moyer, 2012)

35. References
Barbieri, R. L. (2016, August 23). Evaluation of acute pain in women. Retrieved March 17, 2017, from Uptodate: pain-in-women?source=search_result&search=pelvic%20pain&selectedTitle=1~150
Beckmann, C. R., Ling, F. W., Herbert, W. N., Laube, D. W., Smith, R. P., Casanova, R., et al. (2014). Obstetrics and gynecology, seventh edition. Baltimore: Lippincott Williams & Wilkins.
Braaten, K. P., & Dutton, C. (2016, February 7). Overview of female sterilization. Retrieved March 10, 2017, from Uptodate: sterilization?source=search_result&search=permanent%20sterilization&selectedTitle=1~ 150
Center for Disease Control and Prevention. (2010). MMWR 2010;55(No RR-12). Alanta: U.S Department of Health and Human Services.
Cervical polyps. (2017, March ). Retrieved March 18, 2017, from University of Florida health:
Curtis, K. M., Tepper, N. K., Jatlaoui, T. C., Berry-Bibee, E., Horton, L. G., Zapata, L. B., et al. (2016). U.S. Medical Eligibility Criteria for Contraceptive Use, MMWR Recomm Rep 2016;65(No. RR-3),
Effectiveness of family planning methods. (2011). Retrieved March 11, 2017, from raceptive_methods_508.pdf

36. References
Fibroids. (2015, May 12). Retrieved March 15, 2017, from slideshare.net:
Hoffman, B. L., Schorge, J. O., Schaffer, J. I., Halvorson, L. M., Bradshaw, K. D., & Cunningham, F. G. (2012). Williams Gynecology, second edition. McGraw-Hill.
Kaunitz, A. M. (2016, 13 October). Approach to abnormal uterine bleeding in nonpregnant reproductive-age women. Retrieved March 11, 2017, from Uptodate: nonpregnant-reproductive-age- women?source=search_result&search=irregular%20menses&selectedTitle=1~150
Kaunitz, A. M. (2016, 15 November). Contraceptive counseling and selection. Retrieved March 15, 2017, from Uptodate: counseling-and- selection?source=search_result&search=contraception&selectedTitle=1~150
Mayo Clinic Staff. (2017). HPV infection. Retrieved March 10, 2017, from Mayoclinic.org:
Meites, E., Kempe, A., & Markowitz, L. (2016, December 16). Use of a 2-dose schedule for human papillomavirus vaccination-updated recommendations of the advisory committee on immunization practices. Retrieved March 16, 2017, from MMWR 2016; 65: :

37. References
Moyer, V. A. (2012, March). Screening for cervical cancer: U.S. preventive services task force recommendation statement. Retrieved March 10, 2017, from Uspreventiveservicestaskforce.org: ervical-cancer-screening
Palefsky, J. M., & Cranston, R. D. (2015, May 10). Virology of human papillomavirus infections and the link to cancer. Retrieved March 10, 2017, from uptodate: and-the-link-to-cancer?source=search_result&search=HPV&selectedTitle=1~150
Polyps. (n.d.). Retrieved March 15, 2017, from Womens-health-advice.com:
STD Tx guide . (2015). Retrieved March 10, 2017, from Google play: ct=8&ved=0ahUKEwjM1fvV7NHSAhWJxYMKHXVaBtcQjRwIBw&url=https%3A%2F%2Fplay. google.com%2Fstore%2Fapps%2Fdetails%3Fid%3Dgov.cdc.stdtxguide&bvm=bv ,d.cGc&psig=AFQjCNFA86LGWlX0Y
The American College of Obstetrics and Gynecologists. (2013). Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Committee on Gynecologic Practice.
The dreaded pap test: Opening up (literally) about my experiences. (2013, October 27). Retrieved March 10, 2017, from Randomdysfunctions.com: