Essentials of Human Diseases and Conditions 4th edition

1
Essentials of Human Diseases and Conditions 4th
edition

• Margaret Schell Frazier
• Jeanette Wist Drzymkowski

2
Chapter 12 Diseases and Conditions of the
Reproductive System
3
Learning Objectives

• Identify risk factors for sexually transmitted
  diseases (STDs).
• Explain what a silent STD is, and give an
  example.
• Name the complications of untreated gonorrhea.
• Recall how trichomoniasis is diagnosed.
• Explain how genital herpes is transmitted.
• Explain why women with genital herpes are advised
  to have regular Pap (Papanicolaou) smears.

4
Learning Objectives (contd.)

• Describe the stages of untreated syphilis.
• Explain why hepatitis B is classified as sexually
  transmitted.
• List the possible causes of dyspareunia in men
  and women.
• Name drugs that can contribute to impotence.
• Name a common causative factor in male and female
  infertility.

5
Learning Objectives (contd.)

• Explain the value of prostate-specific antigen
  (PSA) as a screening test.
• Discuss the medical interventions for prostatic
  cancer.
• Explain how varicocele may contribute to male
  infertility.
• Explain why physicians encourage monthly
  testicular self-examinations for younger men.

6
Learning Objectives (contd.)

• Explain what causes the dysmenorrhea associated
  with endometriosis.
• Discuss the importance of early diagnosis and
  prompt treatment of pelvic inflammatory disease.
• Discuss the advantages and possible risks of
  hormone replacement therapy for the
  postmenopausal woman.

7
Learning Objectives (contd.)

• Explain how uterine prolapse, cystocele, and
  rectocele may be corrected surgically.
• List the risk factors for cervical cancer.
• Name the leading cause of deaths attributed to
  female reproductive system disorders.
• List some possible causes of ectopic pregnancy.

8
Learning Objectives (contd.)

• Explain how a pregnant woman is monitored for
  toxemia.
• Describe abruptio placentae.
• List the factors that place women at higher risk
  for breast cancer.

9
Chapter 12Lesson 12.1
10
The Normally Functioning Reproductive Systems

• The human reproductive system is classified into
  two groups
• Gonads produces germ cells and hormones
• Testes (males)
• Ovaries (females)
• Ducts transport germs cells

11
The Normally Functioning Reproductive Systems
(contd.)

• Both the male and female reproductive systems are
  vulnerable to a number of diseases or
  dysfunctions
• The origin of these conditions may be
• Functional
• Structural
• Emotional

12
Sexually Transmitted Diseases

• More than 20 infectious diseases are spread by
  sexual contact
• Sexually transmitted diseases (STDs) are spread
  from one person to another through bodily fluids
  (blood, semen, vaginal secretions) during
  vaginal, anal, or oral sex
• Some spread by direct contact with infected skin

13
Sexually Transmitted Disease Risk Factors

• A person is at greater risk for getting an
• STD if he or she
• Has sex without knowledge of partners history
• Shares drug-related needles
• Has sex with multiple partners
• Has direct skin contact with an open wound of an
  infected person

14
Chlamydia

• One of the most frequently reported infectious
  diseases in the U.S.
• More common than gonorrhea and the leading cause
  of pelvic inflammatory disease and sterility in
  women
• Sometimes called the silent STD because it often
  has no symptoms

15
Chlamydia (contd.)

• Symptoms
• When symptoms are present they are evidenced in
  both females and males and include
• Females
• Thick vaginal discharge with burning sensation
• Itching
• Abdominal pain
• Pain during intercourse (dyspareunia)

16
Chlamydia (contd.)

• Males
• Discharge from penis with burning sensation
• Itching
• Burning sensation when urinating
• Scrotum may be swollen

17
Chlamydia (contd.)

• Treatment
• Antibiotic therapy is given to both partners
• Initially a single injection
• Followed by oral antibiotics
• Patients are encouraged to abstain from
  intercourse until both partners are cured

18
Gonorrhea

• A common STD with symptoms similar to chlamydia
• Additional symptoms
• A discharge of pus from the genital tract in both
  males and females
• Difficult or painful urination
• Symptoms vary in severity

19
Gonorrhea (contd.)

• Treatment
• Antibiotic therapy for both partners
• Because many strains of the bacteria that cause
  gonorrhea have become resistant to standard
  antibiotic therapy (tetracycline and penicillin),
  follow-up cultures are routinely ordered to
  ensure a complete cure

20
Gonorrhea (contd.)

• Neglecting treatment can lead to the following
  complications
• Pelvic inflammatory disease
• Blood poisoning (septicemia)
• Septic arthritis

21
Trichomoniasis

• Infection of the lower genitourinary tract
• Affects about 15 percent of sexually active
  people
• Most infected men and women are without symptoms

22
Trichomoniasis (contd.)

• Symptoms
• When symptoms are present they are evidenced in
  both females and males and include
• Difficult or painful urination
• Itching
• Women profuse greenish yellow discharge from the
  vagina

23
Trichomoniasis (contd.)

• Diagnosis
• Discharge from either the male or female is
  typically studied for the microorganism
  responsible.
• Urinalysis may be performed
• Cervix may also be examined for the presence of
  small hemorrhages with a strawberry-like
  appearance

24
Trichomoniasis (contd.)

• Treatment
• Anti-infective drugs are given orally or in some
  cases vaginally.
• Follow-up examinations to ensure the infection
  has been eliminated

25
Genital Herpes

• Infection of the skin in the genital area
  resulting in painful genital sores
• Spread by direct skin-to-skin contact
• Caused by herpes simplex virus type 2 (HSV-2)
• Large percentage of infections go unnoticed

26
Genital Herpes (contd.)

• Symptoms
• One or more blister-like lesions on or around the
  genitals or anus
• Swollen glands
• Fever
• Headache
• Painful urination

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Genital Herpes (contd.)

• Diagnosis
• Presence of characteristic lesions on the male or
  female genitalia
• An antigen test or tissue culture may confirm the
  diagnosis.

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Genital Herpes (contd.)

• Treatment
• There is no cure.
• Prescription drugs are routinely used to reduce
  the frequency and duration of outbreaks.
• Women with genital herpes are at increased risk
  for cervical cancer and are encouraged to obtain
  a Pap smear every six months for screening.

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Genital Warts (Condylomata Acuminata)

• A genital infection that causes raised
  cauliflower-like growths in or near the vagina or
  rectum or along the penis
• Warts are caused by the human papillomavirus
  (HPV) and is usually transmitted through sexual
  contact.

30
Genital Warts (contd.)

• Symptoms
• Possible itching or burning
• Discomfort varies by size, number, and location
• Added risk factor
• Women with HPV infection are at greater risk for
  cervical cancer

31
Genital Warts (contd.)

• Treatment
• Topical drug therapy
• Surgical procedures
• Cryosurgery freezing and removing affected
  tissue
• Electrodesiccation removing warts using lasers
• Some genital warts disappear without treatment

32
Syphilis

• A chronic, sexually transmitted infection that
  can affect the entire body if left untreated

33
Syphilis (contd.)

• Symptoms manifest in four stages
• Presence of a painless but highly contagious
  local lesion called a chancre (pronounced
  shang-ker) found on the genitalia
• Within one-two months, the primary lesion heals,
  but the infection spreads throughout the body and
  can cause similar lesions anywhere

34
Syphilis (contd.)
35
Syphilis (contd.)

• Symptom stages
• The infection begins spreading systemically
  throughout the body and may present with
• Fever
• Headache
• Aching joints
• Mouth sores
• Rashes on palms or soles of feet

36
Syphilis (contd.)

• Symptom stages
• A latent period follows where the infection is
  without symptoms but can be transmitted in the
  first few years of this stage.
• This stage can last from one to 40 years and
  varies by person.

37
Syphilis (contd.)

• Symptom stages
• In the final stage, lesions (called gummas)
  invade the body organs and systems and cause
  widespread damage that can be disabling and
  life-threatening.

38
Syphilis (contd.)

• Treatment
• Can be cured with a course of antibiotic therapy
  using penicillin G
• Patients are monitored with follow-up blood tests
  for up to one year to ensure elimination of
  infection.

39
Chancroid

• A bacterial infection of the genitalia that
  causes a shallow and painless lesion on the skin
  or mucous membrane that appears seven to 10 days
  after sexual contact with an infected person
• Symptoms
• Over time, ulcer usually deepens and oozes pus

40
Chancroid (contd.)

• Treatment
• Antibiotic therapy
• Lesions must sometimes be drained surgically
• Good personal hygiene
• Refrain from sexual contact during treatment

41
Hepatitis B

• An infection of the liver that is caused by a DNA
  virus
• The disease has a long incubation and symptoms
  may become severe or chronic, causing serious
  damage to the liver

42
Hepatitis B (contd.)

• Causes
• Can be transmitted by
• Contaminated blood or blood derivatives in
  transfusions
• Sexual contact with an infected person
• Use of contaminated needles and instruments

43
Hepatitis B (contd.)

• Symptoms
• Fatigue
• Loss of appetite
• Nausea
• Abdominal discomfort
• Dark urine
• Clay-colored bowel movements
• Yellowing of the skin and eyes (jaundice)

44
Hepatitis B (contd.)

• Treatment
• Some cases are self-limiting
• Medications to control nausea and pain
• Low-fat, high-carbohydrate diet
• Restriction of physical activity
• Alcohol should be avoided at all costs because of
  its potential to strain the liver
• Antiviral therapy for chronic cases

45
Hepatitis B (contd.)

• Prognosis
• Acute cases prognosis is good
• Liver heals and regenerates
• May take several months
• Chronic cases prognosis is poor
• Inflammation causes destruction of liver cells
  and possible liver failure

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Chapter 12Lesson 12.2
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Sexual Dysfunction

• Sexual dysfunction is the abnormal or impaired
  function of sexual behavior resulting from
  physical and/or mental imbalances in the system

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Dyspareunia

• Refers to recurrent painful or difficult sexual
  intercourse
• Can occur in men and women but is more common in
  women

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Dyspareunia (contd.)

• Physical causes (women)
• Intact hymen
• Insufficient lubrication
• Presence of an STD
• Use of spermicide
• Endometriosis
• Pelvic inflammatory disease
• Presence of cysts or tumors in pelvic region

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Dyspareunia (contd.)

• Psychological causes (women)
• Past trauma
• Sexual abuse
• Fears (including fear of pregnancy)
• Anxiety

51
Dyspareunia (contd.)

• Causes (men)
• A bowed erection
• Tight foreskin
• Inflammation of the prostate
• Anxiety or guilt

52
Dyspareunia (contd.)

• Treatment
• Determined by cause but could include
• Use of lubricants during intercourse
• Gentle stretching of vaginal opening
• Treat existing infections
• Address psychosexual issues in counseling
• Corrective surgery, if necessary

53
Erectile Dysfunction (ED)/Impotence

• Description
• The inability of a man to perform sexual
  intercourse, usually because he is unable to
  attain or maintain an erection of the penis

54
ED/Impotence (contd.)

• Medical conditions
• Diabetes mellitus
• Heart disease
• High cholesterol
• Hypertension
• Nerve disorders arising from
• Prostate surgery
• Trauma

• Psychological causes
• Depression
• Unconscious guilt
• Sexual trauma
• Discordant relationships
• Anxiety about sex
• Chronic fatigue
• Stress

55
ED/Impotence (contd.)

• Other causes
• Medications used to treat hypertension and
  depression
• Alcohol
• Recreational drugs
• Antihistamines
• Diuretics

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ED/Impotence (contd.)

• Diagnosis
• Physical examination
• Lab tests to rule out organic disease
• Measurement of testosterone level
• Medical history of patient and family
• Any chronic disease such as diabetes,
  hypertension heart disease, renal or vascular
  problem, etc.
• Lifestyle habits such as smoking, alcohol use,
  stress levels, and degree of sexual activity

57
ED/Impotence (contd.)

• Treatment
• Change or discontinue medications
• Testosterone therapy
• Psychological counseling
• Penile implants/injection therapy
• External vacuum therapy
• Oral drug therapy

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Frigidity

• The lack of sexual desire or response in a woman
• A patient may report an inability to experience
  sexual arousal, excitement, or achieve an orgasm.

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Frigidity (contd.)

• Causes
• Medications
• Chronic fatigue
• Stress
• Depression
• Past trauma such as rape or sexual abuse

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Frigidity (contd.)

• Treatment
• Training to enhance sensation and focus
• Psychological counseling
• Drug therapy (testosterone cream) to help
  increase libido

61
Premature Ejaculation

• Ejaculation of semen that occurs prior to or
  immediately after penetration of the vagina by
  the penis
• Problematic in that it may allow for little
  foreplay or may result in an inability to satisfy
  partner or impregnate

62
Premature Ejaculation (contd.)

• Causes
• Psychological guilt or anxiety
• Relational a troubled or negative relationship
  with a sex partner
• Diseases infections or neurological conditions

63
Premature Ejaculation (contd.)

• Treatment
• Address underlying psychological issues
• Techniques for delaying ejaculation

64
Male and Female Infertility

• The involuntary inability to conceive
• With regular unprotected intercourse, about 90
  percent of couples conceive within one year
• Of those unable approximately 40 percent can be
  attributed to male factors, 40 percent more to
  female factors, and less than 10 percent unknown

65
Male and Female Infertility (contd.)

• Causes (male)
• Insufficient number of sperm
• Inadequate motility (movement) of sperm
• Presence of an STD or any infection or blockage
• Other physical conditions (genetic disorders) or
  injuries (radiation exposure, hormonal
  imbalances) that may result in sterility

66
Male and Female Infertility (contd.)

• Causes (female)
• STD or infection of the reproductive system
• Failure to ovulate
• Endometriosis
• Blocked fallopian tubes
• Congenital structural or chromosomal disorders
• Scar tissue from infection, ectopic pregnancy, or
  surgery
• Psychological distress

67
Male and Female Infertility (contd.)

• Diagnosis
• Men
• Medical history with special attention to
  childhood diseases
• Thorough physical exam
• Semen analysis

68
Male and Female Infertility (contd.)

• Diagnosis
• Women
• Charting of menstrual cycle
• Blood tests to asses hormone levels
• Visual examination of fallopian tubes and uterine
  cavity using radiography to determine tubal
  patency
• Laparoscopy may be necessary to rule out
  endometriosis

69
Male and Female Infertility (contd.)

• Treatment
• Varies based on diagnosed problem, but commonly
  includes
• Infection control
• Surgery to remove blockage
• Use of fertility drugs
• Artificial insemination
• Intrauterine insemination (IUI)
• In vitro fertilization (IVF)

70
Male Reproductive Diseases

• Most commonly affected organ is the prostate
  gland
• The gland can become inflamed or enlarged as a
  result of bacteria and cause urinary problems.
• Symptoms may include
• Urinary problems (incontinence, difficulty
  urinating)
• Pain or swelling of reproductive organs
• Sexual dysfunction (ED/impotence)

71
Epididymitis

• The inflammation of the epididymis, which is a
  long convoluted tube in the sperm duct system
  located in the testes

72
Epididymitis (contd.)

• Symptoms Signs
• Fever
• Dysuria
• Malaise
• Groin or scrotal tenderness/pain
• Difficulty walking
• Epididymis may become enlarged, tender, or hard
• Prehns sign

73
Epididymitis (contd.)

• Causes
• STDs (gonorrhea and syphilis)
• Urinary tract infection
• Inflamed prostate (prostatitis)

74
Epididymitis (contd.)

• Diagnosis
• Physical examination
• Urinalysis
• Urine cultures

75
Epididymitis (contd.)

• Treatment
• Antibiotic therapy
• Analgesics (pain relief)
• Anti-inflammatories
• Rest
• Avoidance of alcohol and spicy foods
• Scrotum support elevation

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Orchitis

• Orchitis is an infection of the testis causing
• Swelling
• Tenderness
• Acute pain
• Fever
• Chills
• Nausea/vomiting
• General malaise

77
Orchitis (contd.)

• Causes
• May be an infection from the mumps virus
• Can also be attributed to other viruses and
  bacteria
• May follow epididymitis
• May accompany the presence of an STD

78
Orchitis (contd.)

• Treatment
• Antibiotic therapy (if infection is bacterial)
• Mumps virus has no specific treatment besides
• Bed rest
• Adrenal steroid drugs (reduces fever and swelling
  in severe cases)
• Scrotum support

79
Torsion of the Testicle

• A condition where one testicle is twisted out of
  its normal position, causing a reduction in blood
  flow to the affected testicle
• The primary symptom is sudden, severe pain in one
  testicle
• The scrotum becomes red, swollen, and tender
• Fever and urinary frequency may occur

80
Torsion of the Testicle (contd.)
81
Torsion of the Testicle (contd.)

• Diagnosis
• Patient history
• Gentle physical examination
• Ultrasound may be necessary to distinguish
  torsion from epididymitis

82
Torsion of the Testicle (contd.)

• Treatment
• Gentle manipulation to untwist the testicle
• Surgery may be necessary if the above fails to
  correct problem

83
Varicocele

• The veins of one testicle become abnormally
  distended, causing swelling around the testicle
• Symptoms include
• Discomfort (especially in hot weather or
  following exercise)
• Possible lower sperm count

84
Varicocele (contd.)

• Treatment
• Use of scrotal support
• Surgery may be indicated to remove distended
  veins if fertility is threatened

85
Prostatitis

• Acute or chronic inflammation of the prostate
  gland
• Infection (bacterial or nonbacterial) is the most
  likely cause

86
Prostatitis (contd.)

• Symptoms
• Pain or burning sensation during urination
• Low back pain
• Fever
• Muscular pain and tenderness
• Frequent urination
• Blood in urine possible

87
Prostatitis (contd.)

• Treatment
• Antimicrobial penicillin and other antibiotics
• Sitz baths
• Rest
• Increase fluid intake
• Analgesics (for pain)

88
Benign Prostatic Hyperplasia (BPH)

• A nonmalignant, noninflammatory enlargement of
  the prostate gland
• Symptoms
• May compress urethra and cause urinary blockage
• Difficulty starting urination
• Weak urinary stream
• Inability to empty bladder

89
Benign Prostatic Hyperplasia (contd.)

• Treatment
• Watchful waiting
• Control fluid intake before bedtime
• Avoid medications that cause urinary retention
  (decongestants)
• Drug therapy (to relax tightened muscles inside
  the prostate or shrink enlarged prostate gland)
• Surgery may be performed to remove urinary tract
  obstruction

90
Prostate Cancer

• Malignancy of the prostate gland
• Risk factors
• Age (most cases occur in men over age 45)
• Heredity (presence of certain genes)
• Lifestyle (diet high in animal fat, low in
  vegetables and selenium)
• Ethnicity (more common in African-Americans)

91
Prostate Cancer (contd.)

• Symptoms
• Weak or interrupted urine flow
• Frequent urination
• Difficulty starting or stopping urination
• Urinary retention
• Blood in urine
• Erectile dysfunction

92
Prostate Cancer (contd.)

• Diagnosis
• Digital rectal exam
• Blood test to determine level of prostate
  specific antigen (PSA)
• Biopsy (indicated if PSA level is 10ng/ml)

93
Prostate Cancer (contd.)

• Treatment
• Type of treatment depends on several factors
• PSA level
• Age
• Stage of disease
• Physical condition of patient

94
Prostate Cancer (contd.)

• Treatment options
• Radical resection of the prostate (TURP)
• Hormone therapy (for metastatic prostate cancer)
• Radiation therapy
• No intervention (for men 70 years or older or who
  have other co-existing illnesses)

95
Prostate Cancer (contd.)

• Prevention
• Annual screening for all men 50 years of age or
  older, which consists of
• Digital rectal exams
• Serum PSA test
• If either test is positive transrectal ultrasound
  biopsy is performed

96
Testicular Cancer

• Malignant tumor of the testis
• Symptoms
• Nodule on or swelling of one testicle
• Dull ache or heavy sensation in abdomen
• Advanced disease symptoms
• Lower extremity swelling
• Anorexia
• Bone pain

97
Testicular Cancer (contd.)

• Risk factors
• Family history of testicular cancer
• A testicle that has not descended into the
  scrotum
• Infertility
• HIV infection

98
Testicular Cancer (contd.)

• Diagnosis
• Physical examination of the testes to detect
  possible nodes
• Suspected testicular cancer may be followed by
• Scrotal ultrasound
• CT scan of abdomen and pelvis
• Chest x-ray
• Blood tests

99
Testicular Cancer (contd.)

• Treatment
• Chemotherapy
• Surgical resection
• Radiation therapy

100
Testicular Cancer (contd.)

• Prevention
• Monthly testicular self-exam is the most reliable
  screening method
• Enhances body awareness (allows males to assess
  the normal size and shape of testicles)
• Enables early detection of abnormalities

101
Chapter 12Lesson 12.3
102
Female Reproductive Diseases

• The female reproductive organs are susceptible to
  disease in two distinct ways
• Microorganisms can invade the organs, allowing
  infections to develop
• Tumors (both benign and malignant) and cysts can
  develop

103
Premenstrual Syndrome

• A cluster of physical and emotional symptoms that
  appear shortly after ovulation and subside with
  the onset of menstruation or shortly thereafter.

104
Premenstrual Syndrome (contd.)

• Common symptoms
• Anxiety
• Anger
• Sadness
• Food cravings
• Fatigue
• Breast tenderness
• Irritability

• Some women also
• experience
• Edema
• Bloated feeling
• Abdominal pain

105
Premenstrual Syndrome (contd.)

• Treatment
• Directed toward the relief of symptoms
• Reduce dietary intake of sodium
• Moderate exercise
• Mild analgesics
• Diuretics
• Emotional support
• Antidepressant medication or hormone therapy
  especially for PMDD
• Increase calcium intake

106
Amenorrhea

• The absence of menstrual periods
• Two classifications
• Primary if menstruation has not occurred by age
  16
• Secondary no menses after a woman has been
  having menstrual cycles

107
Amenorrhea (contd.)

• Causes of Primary Amenorrhea
• Late onset of puberty
• Abnormalities of the reproductive system
• Hormonal imbalances

108
Amenorrhea (contd.)

• Causes of Secondary Amenorrhea
• Hormone-related issues such as
• Pregnancy
• Emotional factors
• Illness (anorexia, malnutrition, sudden weight
  gain or loss)
• Pituitary tumors
• Thyroid disease
• Excessive athletic training

109
Amenorrhea (contd.)

• Diagnosis
• Physical examination that includes
• Pelvic exam (rules out physical abnormalities and
  pregnancy)
• Blood tests (detects hormone problems)
• Urine samples (detects hormone problems)
• Radiographic studies (detects tumors)

110
Amenorrhea (contd.)

• Treatment of Primary or Secondary
• Treat underlying condition if possible
• Contraceptive hormones or cyclic progesterone
• May require long-term hormone therapy

111
Dysmenorrhea

• Pain associated with menstruation
• Two classifications for cause
• Primary
• Results from normal hormonal changes (not
  considered a pathologic disorder)
• Secondary
• Usually caused by underlying disorder or disease
  (pelvic infections, fibroids, endometriosis, etc.)

112
Dysmenorrhea (contd.)

• Symptoms
• Pain or cramping shortly before or after
  the onset of menstrual flow
• Pain in the uterine area, lower pelvis that may
  radiate to thighs and buttocks
• Painful bowel or bladder function
• Symptoms usually abate by the end of menstruation

113
Dysmenorrhea (contd.)

• Treatment
• Non-steroidal anti-inflammatory drugs
  (prescription or OTC) for pain relief
• Heating pad for abdominal pain
• Hormonal therapy or surgery may be necessary if
  endometriosis, fibroids, or if cervical
  abnormalities are present

114
Ovarian Cysts

• Fluid-filled semi-solid or solid masses that
  originate within ovaries
• Two types
• Physiologic cysts (those caused by normal
  functioning of the ovary)
• Neoplastic cysts (benign or malignant and not
  related to normal functioning)

115
Ovarian Cysts (contd.)

• Symptoms
• Most are small and unnoticed by the patient
• Large cysts can cause urinary retention
• If cyst produces hormones various symptoms result
• Cysts may twist on themselves causing pain,
  nausea and vomiting

116
Ovarian Cysts (contd.)

• Treatment
• Small cysts are common and seldom require
  treatment
• Large cysts
• Can be drained or removed

117
Endometriosis

• A condition in which the endometrial tissue
  implants outside the uterus in the pelvic cavity
  or in other distant sites

118
Endometriosis (contd.)

• Symptoms
• Secondary dysmenorrhea is a classic symptom
• Constant pain and cramping in lower abdomen
  beginning before and lasting several days after
  menstruation
• Infertility
• Pelvic pain during intercourse
• Pain during defecation

119
Endometriosis (contd.)

• The thickening and bleeding in these unnatural
  areas (and the resulting cysts, scar tissue, and
  adhesions) are the cause of pain and discomfort.
• Risk factors include family history of the
  disease, menstrual cycles shorter than 28 days,
  uterine structural abnormalities and periods
  lasting longer than a week.

120
Endometriosis (contd.)

• Treatment
• Hormone treatment for younger patients
• Pregnancy, nursing, and menopause usually bring a
  remission of symptoms
• Surgery to remove or destroy endometrial growth
• Total hysterectomy with bilateral
  salpingo-oophorectomy may be indicated in severe
  cases

121
Pelvic Inflammatory Disease (PID)

• An infection of a womens pelvis
• Is self limiting to life-threatening

122
Pelvic Inflammatory Disease (contd.)

• Symptoms
• Fever
• Chills
• Malaise
• Foul-smelling vaginal discharge
• Backache
• Painful, tender abdomen

123
Pelvic Inflammatory Disease (contd.)

• Diagnosis
• There is tenderness during vaginal exam
• Signs include elevated WBC and fever
• Ultrasonography may be used to identify abcess
  formation
• Laparoscopy is helpful to confirm diagnosis

124
Pelvic Inflammatory Disease (contd.)

• Treatment
• Aggressive antibiotic therapy to treat disease
  and help prevent complications
• Analgesics
• Bed rest
• Without effective treatment, serious and
  life-threatening complications can develop

125
Leiomyomas (fibroids)

• Leiomyomas are benign tumors of the smooth muscle
  within the uterus

126
Leiomyomas (fibroids) (contd.)

• Symptoms
• Most do not cause any symptoms
• If present, they often include
• Heavy and prolonged periods
• Pelvic pain and pressure
• Constipation
• Frequent urination
• Abnormal bleeding

127
Leiomyomas (fibroids) (contd.)

• Treatment
• Depends on
• Severity of symptom
• Age of patient
• Desire to bear children
• Treatment options
• Surgery to remove tumors (childbearing age)
• Hysterectomy (if bleeding continues)
• Ultrasound ablation
• Uterine artery embolization

128
Vaginitis

• The inflammation and/or infection of the vaginal
  tissues
• Fungal infection most common cause or may be
  bacterial or protozoan
• Cervical infections may be mistaken for vaginitis
• Postmenopausal women are also at greater risk

129
Vaginitis (contd.)

• Symptoms
• Vaginal discharge
• Itching/burning sensation of the vulva
• Fever may be present

130
Vaginitis (contd.)

• Treatment
• Hormone therapy
• Antibiotic therapy
• Vaginal antifungal/steroid cream
• If vaginitis is contracted by sexual contact,
  both partners must be treated

131
Toxic Shock Syndrome

• An acute, systemic infection that has been
  associated with menstruating females who use
  vaginal tampons

132
Toxic Shock Syndrome (contd.)

• Cause
• Fibers of super-absorbent tampon create an ideal
  environment for bacteria to produce toxins
• Staphylococcal infection is responsible for TSS
• Can also occur in women using contraceptive
  sponges or diaphragms

133
Toxic Shock Syndrome (contd.)

• Symptoms
• Sudden onset of high fever
• Headache
• Sore throat
• Rash
• Low blood pressure (hypotension)
• Shock

134
Toxic Shock Syndrome (contd.)

• Treatment
• Replacement of fluids to counteract shock
• Antibiotic therapy
• Without prompt treatment, condition can result in
  neurological, renal, and respiratory
  complications and death

135
Menopause

• Represents the cessation of menstrual periods
• Menstruation discontinues due to ovaries
  producing less estrogen, which inhibits ovulation
• Changes in pituitary hormone levels bring
  physical and psychological changes

136
Menopause (contd.)

• Symptoms
• Fluctuations in menstrual cycle
• Periods become lighter and less frequent
• Hot flashes/night sweats
• Vaginal dryness/skin changes

137
Menopause (contd.)

• Treatment
• Consists of management of symptoms
• Recent research links HRT with increased rates
  of
• Breast cancer
• Heart disease
• Stroke
• Blood clots

138
Menopause (contd.)

• Alternate symptom management is suggested
• Consumption of soy products to replace missing
  hormones (high in isoflavones)
• Medications to strengthen bones, lower
  cholesterol, and help relieve vaginal dryness

139
Uterine Prolapse

• Prolapse of the uterus is a downward displacement
  of the uterus from its normal location in the
  body
• The uterus becomes prolapsed when the pelvic
  floor muscles and ligaments become extremely
  overstretched or weakened

140
Uterine Prolapse (contd.)
141
Uterine Prolapse (contd.)

• Treatment
• Kegel exercise to strengthen the pelvic floor
  muscles
• Weight loss
• High-fiber diet
• Insertion of supportive uterine device (pessary)
• Surgery (for serious prolapse)

142
Rectocele

• Protrusion of the rectum into the posterior
  portion of the vagina
• Occurs when the posterior wall of the vagina is
  weakened
• Could result from trauma to the area during
  childbirth

143
Rectocele (contd.)

• Symptoms
• A bearing-down feeling
• Constipation
• Incontinence of gas/feces
• Difficulty with eliminating feces

144
Rectocele (contd.)

• Treatment
• Surgical repair of the posterior wall of the
  vagina
• Prognosis is good with surgical repair

145
Chapter 12Lesson 12.4
146
Cervical Cancer

• Malignant cell growth that is located in the
  cervix region
• Most cervical cancers are squamous cell
  carcinomas and occur in the area between the
  uterus and vagina.

147
Cervical Cancer (contd.)

• Symptoms
• Abnormal Pap smear test result
• Watery, bloody vaginal discharge
• Bleeding between menstrual periods and/or after
  intercourse or after menopause

148
Cervical Cancer (contd.)

• Advanced stage symptoms include
• Pelvic and lower back pain
• Blood in urine
• Painful urination
• Rectal bleeding

149
Cervical Cancer (contd.)

• Risk factors
• Not having routine Pap smears
• Exposure to human papilloma virus (HPV) most
  often through unprotected sexual contact
• Smoking
• Low socioeconomic status

150
Cervical Cancer (contd.)

• Treatment
• Early stage
• Laser therapy
• Cryoablation (removal by freezing)
• Electrocoagulation (high-frequency electric
  current that destroys tissue)
• Later stage
• The above plus radiation therapy and chemotherapy

151
Cervical Cancer (contd.)

• Prevention
• Sexually active women should obtain annual Pap
  smear and pelvic examination
• After three consecutive normal Pap smears,
  screening can be less frequent as determined by
  doctor
• Screening can cease at age 65-70 for women with
  no risk factors

152
Vaginal Cancer

• Malignancy found typically on the vaginal wall
• Vaginal cancer is rare and thought to be related
  to
• HPV infection
• Prior history of gynecological malignancy
• Advanced age
• Multiple lifetime sexual partners
• Early age at first intercourse
• Cigarette smoking

153
Vaginal Cancer (contd.)

• Symptoms
• Vaginal bleeding following sex or postmenopausal
• Foul-smelling or watery vaginal discharge
• Painful urination
• Constipation
• Black, tarry stool
• Vaginal mass

154
Vaginal Cancer (contd.)

• Treatment
• Surgery usually includes
• Hysterectomy
• Partial or complete removal of vagina
• Partial or complete removal of lymph glands in
  the pelvic region
• Radiotherapy (may be used with surgery or may be
  sufficient alone to treat early-stage vaginal
  cancers)

155
Vaginal Cancer (contd.)

• Prevention
• Regular Pap smears
• Using barrier contraceptives
• Limiting the number of sexual partners

156
Labial or Vulvar Cancer

• Malignancy of the area external to the female
  genitalia (vulva) which includes the labium (any
  of four folds of tissue on the outer portion)

157
Labial or Vulvar Cancer (contd.)

• Symptoms
• Presence of a nodule or ulcer on
• Labia major and/or labia minor
• Clitoris
• Vulvar bleeding
• Discharge
• Painful urination
• Enlarged lymph node in the groin

158
Labial or Vulvar Cancer (contd.)

• Risk factors
• Cigarette smoking
• Presence of HPV, HIV, or herpes simplex virus
  type 2
• Prior history of cervical, endometrial, or breast
  cancer
• Northern European ancestry

159
Labial or Vulvar Cancer (contd.)

• Diagnosis
• Requires excision biopsy of lesion
• Examination of regional lymph nodes is mandatory
  to determine whether tumor has metastasized and
  may also include other tests to examine related
  areas

160
Labial or Vulvar Cancer (contd.)

• Treatment
• Surgical removal of the growth and surrounding
  skin or complete or partial removal of the vulva
  itself (vulvectomy)
• Radiation and chemotherapy may be used in
  combination with surgery for advanced-stage cancer

161
Ovarian Cancer

• Malignancy of one or both ovaries
• Ovarian cancer accounts for more deaths than any
  other gynecological malignancy, because ovaries
  are located deep within the pelvis and disease is
  often asymptomatic until the advanced stage

162
Ovarian Cancer (contd.)

• Symptoms
• Enlargement of abdomen caused by accumulated
  fluid
• Lower abdominal discomfort
• Lower back pain
• Irregular menstrual cycles
• Frequent urination
• Painful intercourse
• Persistent, vague digestive disturbance

163
Ovarian Cancer (contd.)

• Risk factors
• Age (most diagnosed between ages of 40 and 65)
• History of breast or ovarian cancer
• Factors that may reduce risk
• Pregnancy
• Breast feeding
• Prolonged use of oral contraceptives
• Tubal ligation

164
Ovarian Cancer (contd.)

• Diagnosis
• Sometimes, but rarely, mass is discovered during
  routine pelvic exam
• Laparotomy is indicated once mass is found to
  confirm diagnosis
• Abdominal or pelvic CT scans may be used to
  identify degree of metastasis

165
Ovarian Cancer (contd.)

• Treatment
• Early stage
• Removal of the ovaries, fallopian tubes, and
  uterus
• Advanced stage
• Removal of the above organs in combination with
  chemotherapy

166
Endometrial Cancer

• Malignancy of the lining of the uterus
• It is the most common gynecological malignancy

167
Endometrial Cancer (contd.)

• Symptoms
• Abnormal uterine bleeding at the onset of or
  following menopause
• Abdominal pain (in advanced stage)

168
Endometrial Cancer (contd.)

• Diagnosis
• Endometrial biopsy
• Dilation and curettage (usually performed when
  biopsy is inconclusive)

169
Endometrial Cancer (contd.)

• Treatment
• Early stage
• Surgery
• Advanced stage
• Radiation therapy in combination with surgery

170
Condition and Complications of Pregnancy

• Complications in pregnancy can arise at any point
  in the gestational period
• This further emphasizes the need for early and
  continual prenatal care and patient education

171
Morning Sickness

• Temporary nausea and vomiting experienced with
  the onset of pregnancy through the12th to 16th
  week
• Generally occurs during the day

172
Morning Sickness (contd.)

• Cause
• Elevated
• Estrogen
• hCG levels (hormone produced early in pregnancy
  by the placenta)
• Emotions may also trigger episodes

173
Morning Sickness (contd.)

• Treatment
• Eating smaller amounts of food and simple
  hydration
• Rest, ginger, wrist bands, and vitamins B6 B1
  may help

174
Hyperemesis Gravidarum

• Severe nausea and excessive vomiting that cause
  starvation during pregnancy
• The severity of episodes causes
• Weight loss
• Dehydration
• Fluid and electrolyte imbalance

175
Hyperemesis Gravidarum (contd.)

• Treatment
• Hospitalization (in severe cases)
• Intravenous fluids and electrolyte replacement
• IV antiemetics

176
Spontaneous Abortion (Miscarriage)

• Naturally occurring loss of a fetus before the
  20th week of pregnancy
• About 10-15 percent of all pregnancies terminate
  in spontaneous abortion
• Majority are the result of a fetus with abnormal
  chromosomes

177
Spontaneous Abortion (contd.)

• Symptoms
• Presents with vaginal bleeding
• Cramping pelvic pain
• Positive pregnancy test
• Possible shock (pulse rate increases/blood
  pressure decreases)

178
Spontaneous Abortion (contd.)

• Treatment
• If bleeding is not severe, the mother is treated
  conservatively
• Cervical suture (cerclage) to keep the cervix
  closed
• Severe bleeding or partial expulsion of the
  contents of the uterus requires surgical
  intervention (D C)

179
Ectopic Pregnancy

• Occurs when the fertilized ovum implants and
  grows in a structure outside the uterus, most
  often the fallopian tube
• Ectopic pregnancies can develop when the
  fertilized ovum is unable to enter the uterus and
  is unable to implant and grow

180
Ectopic Pregnancy (contd.)
181
Ectopic Pregnancy (contd.)

• Symptoms
• Sudden onset of severe lower abdominal pain
• Evidence of vaginal bleeding
• No pain or pain on one side
• Positive pregnancy test
• Possible shock and death

182
Ectopic Pregnancy (contd.)

• Treatment
• Laparoscopic surgery to terminate the pregnancy
  and remove fetus and placenta
• Replace lost blood
• Methotrexate (instead of surgery) may be used to
  terminate ectopic pregnancy that has not ruptured

183
Premature Labor

• Premature labor occurs before the 37th week of
  gestation (late second or early third trimester),
  or before the fetus has reached a viable weight
• Symptoms include
• Contractions with cervical change
• Increased vaginal discharge

184
Premature Labor (contd.)

• Predisposing conditions
• Maternal infection
• Uterine abnormalities
• Uterine fibroids
• Incompetent cervix

• Certain risk factors
• Maternal age
• Gum disease
• Infection

185
Premature Labor (contd.)

• There is no effective treatment
• Medical management includes drug therapy
• Monitoring
• Patient
• Fetal heart
• Fetal movement

186
Preeclampsia (Toxemia) and Eclampsia

• Preeclampsia is a serious disease characterized
  by
• Hypertension
• Edema (in some cases)
• Proteinuria (protein in urine)

• Eclampsia is characterized by
• Grand mal seizure in a patient with preeclampsia

187
Preeclampsia (Toxemia) and Eclampsia (contd.)

• Symptoms Preeclampsia
• Sudden weight gain
• Edema (primarily in face, hands, and feet)
• Headaches
• Epigastric pain
• Blood pressure greater than 140/90
• Visual disturbances
• Elevated protein in urine
• Clonus

188
Preeclampsia (Toxemia) and Eclampsia (contd.)

• Etiology Eclampsia
• Unknown
• More common in first pregnancy
• Improves after placenta is delivered

189
Preeclampsia (Toxemia) and Eclampsia (contd.)

• Treatment
• Bed rest when symptoms are mild
• Frequent monitoring of baby and mother
• Monitoring of blood tests
• If symptoms are severe the patient may be
  hospitalized and monitored
• Dark and quiet room (to prevent convulsions)
• Medications (to reduce blood pressure)

190
Abruptio Placentae

• The premature detachment of a normally positioned
  placenta occurring during pregnancy
• When the placenta separates from the uterine wall
  too early during pregnancy, it causes the mother
  to hemorrhage and fetal distress

191
Abruptio Placentae (contd.)

• Symptoms
• Variable bleeding to hemorrhage
• Painful contractions
• Abdominal pain
• Fetal distress
• Fetal heart rate abnormalities
• Fetal death

192
Abruptio Placentae (contd.)

• Cause
• In many cases cause is unknown
• Trauma, infection, maternal vascular disease and
  multiple gestation are predisposing factors
• Women with preeclampsia or who use cocaine are at
  higher risk

193
Abruptio Placentae (contd.)

• Treatment
• Hospitalization
• Bed rest
• Labor may be induced if near term or bleeding is
  excessive
• Surgery if fetal heart rate declines or maternal
  shock is indicated
• Blood replacement may also be needed

194
Placenta Previa

• Condition in which the placenta that is implanted
  in the lower uterine segment encroaches on the
  internal cervical opening, causing bleeding

195
Placenta Previa (contd.)

• Symptoms
• Painless, bright vaginal bleeding
• Abdomen is soft and not tender
• Vital signs may indicate shock
• Fetal blood supply may be compromised
• Prior cesarean delivery and multiple gestation
  increase risk

196
Placenta Previa (contd.)

• Treatment
• Partial PP Close observation and monitoring in
  hospital setting
• Surgery is indicated when fetus is near term or
  bleeding is profuse
• Complete PP Immediate surgical termination of
  the pregnancy (by cesarean section) to save both
  mother and baby

197
Hydatidiform Mole

• An intrauterine tumorous growth that results from
  a genetic anomaly during fertilization
• The patient experiences symptoms that mimic
  pregnancy but usually no fetus develops
• What does develop is a mass of clear grapelike
  vesicles

198
Hydatidiform Mole (contd.)
199
Hydatidiform Mole (contd.)

• Symptoms
• Abnormalities noted on ultrasound
• Uterus increases in size disproportionately to
  gestational age
• Nausea and vomiting
• Greatly elevated hCG levels

200
Hydatidiform Mole (contd.)

• Treatment
• Surgical intervention (D C)
• Observation for hemorrhage
• If mole is found to be cancerous, patient may
  receive chemotherapy

201
Diseases of the Breast

• Diseases of the breast can range from mild to
  fatal and necessitate frequent screening, monthly
  self-examinations, and routine mammograms
• Although most diseases of the breast are most
  common in women, men do experience diseases of
  the breast

202
Cystic Disease of the Breast

• Common, benign breast disorder where lumps and
  cysts develop in one or both breast
• The most common female breast disease
• The breasts are tender when pressure is applied
  and some women may experience shooting pains in
  the breast tissue

203
Cystic Disease of the Breast (contd.)

• Diagnosis
• Physical examination
• Mammogram
• Ultrasonography may be used to determine whether
  lump is hollow or solid

204
Cystic Disease of the Breast (contd.)

• Treatment
• No specific treatment
• Some physicians remove fluid (aspirate) from the
  cysts with a needle
• Other recommendations
• Wearing a firm, supporting bra
• Avoid caffeine
• Avoid smoking

205
Mastitis

• Inflammation of the breast tissue that occurs
  during lactation following birth
• Often caused by a strep or staph infection that
  invades the milk ducts and creates inflammation
  and blockage
• Milk stagnates due to blockage and produces a
  dull pain

206
Mastitis (contd.)

• Symptoms found in breast post delivery
• Sudden pain
• Redness
• Sensation of heat (at either beginning or end of
  lactation period)
• Feels hot, doughy, and tough
• Discharge from nipple

207
Mastitis (contd.)

• Treatment
• Firm, supporti