Reproductive A&P and Disorders

What are the hormones in female reproductive systems?

• Significant hormones and hormonal changes

  • Estrogens

  • Progesterone

  • Androgens

  • Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

What is the health history to do for reproductive system?

• Menstrual history and history of pregnancies

• History of exposure to medications

• Pain with menses or intercourse

• Vaginal discharge, odor, or itching

• Urinary and bowel function

• Sexual history, including sexual or physical abuse

• History of STDs, surgeries, or procedures

• Chronic illness or disabilities that affect health and self- care

• Family and genetic history

What is the sexual history done?

• Assessment includes subjective and objective data

• Purpose is to obtain information to picture a woman’s sexuality and sexual practices to promote sexual health

• May move from less sensitive areas of general health history or assessment to more sensitive areas

• Ask for permission to discuss these issues

• Do not assume sexual preferences

• Asking the patient to label herself as married, single, and so on may be interpreted as inappropriate; asking about current meaningful relationships may be less offensive

• PLISST model

What are some considerations to keep in mind for reproductive health?

• Female genital mutilation or cutting

• Intimate partner violence: physical, sexual, stalking, and psychological aggression

• Incest and childhood sexual abuse

• Health issues in women with disability

• Lesbian, gay, bisexual, transgender or queer (LGBTQ)

• Gerontologic considerations

What is the physical assessment for reproductive system; pelvic examinations?

• Annual breast and pelvic examinations: all women 21 years of age or older and for those who are sexually active, regardless of age

• Alleviate feelings of anxiety with explanations and education

• Patient is asked to empty her bladder and to provide a urine specimen if urine tests are part of the total assessment

• Positioning

• Inspection

• Speculum examination

  • Inspection of cervix

  • Obtaining pap smears and other samples

  • Inspecting vagina

  • Bimanual palpation

  • Cervical, uterine, adnexal, vaginal, and rectal palpation

Breast assessment?

• Anatomic and physiologic overview

• Health history

• Physical assessment: female breast and male breast

  • Inspection, palpation, lymph nodes

• Adolescent, obese

• Gynecomastia

• Refer to Chart 52-1

Diagnostic evaluation for breast issues

• Breast self-examination (BSE; “breast self- awareness”)

  • 5 to 7 days after menses

• Mammography

  • Annually after the age of 45 years

  • Digital and 3D

  • Contrast

• Ultrasonography

• MRI

Things to keep in mind with male reproductive system?

• Includes conditions that affect both reproduction and sexuality and urinary elimination

• Patient may experience anxiety and embarrassment

• Be sensitive to cultural and emotional issues related to sexuality and the genitals to accomplish effective assessment and communication

• Provide for privacy and education

What is the assessment for male reproductive system?

• Urinary function and symptoms

• Sexual function and manifestations of sexual dysfunction

• Symptoms related to urinary obstruction

  • Increased urinary frequency

  • Decreased force of stream

  • “Double” or “triple” voiding

  • Nocturia, dysuria, hematuria, hematospermia

• Presence of conditions that may affect sexual function (diabetes, cardiac disease, multiple sclerosis)

PLISSIT model & BETTER model

• PLISSIT model

  • Permission

  • Limited Information

  • Specific Suggestions

  • Intensive Therapy

• BETTER model includes cancer patients

• Bringing up the topic, explaining, telling, timing, educate about treatment-related sexual side effects, recording

Physical assessment for male reproductive system

• Digital rectal exam

  • Recommended annually for men >50 years old

  • Recommended >45 years of age for high risk; African American and men with family history

• Testicular exam

  • Instruct on testicular self-examination (TSE)

What are some diagnostic tests to evaluate the male reproductive system?

• Prostate-specific antigen (PSA)

• Ultrasonography

• Prostate fluid or tissue analysis

• Tests of male sexual function

What are some types of menstrual disorders?

• Premenstrual syndrome (PMS)

• Dysmenorrhea

• Amenorrhea

• Excessive, irregular, or in-between/unrelated to cycles bleeding

Premenstrual Syndrome (what is it, S&S, tx)

• A cluster of physical, emotional, and behavioral symptoms that are usally related to the luteal phase (2nd half) of the menstrual cycle

• Very common affecting many women at some time in their lives

• S&S: headache, fatigue, low back pain, painful/tender, breasts, abdominal fullness; general irritability mood swings, fear of losing control, depression, anxiety, withdrawal, anger, binge eating, and crying spells

• Premenstrual dysphoric disorder (PMDD) is a severe form of PMS w/ significant severity of symptoms

  • Can be managed

• Pharm tx: SSRIs, naproxen, antianxiety, Ca+, birth control

Dysmenorrhea (what is it, S&S, tx)

• Painful menstruation with no identifiable pelvic pathology

• S&S: crampy lower abdominal pain that begins before or shortly after menstrual flow and continues 48-72 hrs; n/d, dizziness, backache

• Rule out endometriosis, PID, uterine fibroids

• Pharm tx: NSAIDs, local heat

Amenorrhea

• Absence of menstral flow; is a symptom of a variety of disorders and dysfuctions

• Factors: obesity, eating disorders (anorexia and bulimia); intense exercise

Contraception

• Abstinence

• Long-acting reversible contraceptive (LARC)

  • Intrauterine device (IUD), implants

• Sterilization

• Hormonal contraception: oral, transdermal, vaginal, injectable

• Mechanical barriers

  • Diaphragm, cervical cap, female condom, spermicides, male condom

• Coitus interruptus or withdrawal

• Fertility awareness-based methods

• Emergency Contraception

  • Emergency contraceptive pills

  • Postcoital intrauterine device (IUD) insertion

  • Patients who use emergency contraception may be anxious, embarrassed, and lacking information about birth control. The nurse must be supportive and nonjudgmental and provide facts and appropriate patient education.

• Purpose, eucation (benefits/cons)

Abortion

• Interruption of pregnancy or expulsion of the product of conception before the fetus is viable

• Types

  • Spontaneous abortion

  • Habitual abortion

  • Induced abortion

• Medical and nursing management

• Induced abortion

  • Preabortion counseling

  • Pelvic examination and laboratory tests

  • Use of RhoGAM for Rh-negative patient

  • Types of induced abortions

  • Patient education, including instruction for follow- up care and information on contraception

  • Psychological support

Infertility (definition, primary v secondary, factors)

• A couple’s inibility to achieve a pregnancy after 1 year of unprotected intercourse

• Primary infertility referf to couple that has never had a child

• Secondary infertility means at least one conception has occured but the couple cannot achieve a pregnancy

• Pathophysiology:

  • Ovarian and ovulation factors

  • Tubal and uterine factors

  • Male factors

How can infertility be managed?

• Pharmacologic therapy

  • Potential for multiple pregnancies

  • Ovarian hyperstimulation syndrome (OHSS)

• Artificial insemination

• Assisted reproductive technologies

  • In vitro fertilization (IVF)

  • Gamete intrafallopian transfer (GIFT

• Other technologies

• Make sure to give psycosocial suport and stay on hormones

Ectopic Pregnancy (clinical manifestations)

• A leading cause of pregnancy-related death in the first trimester

• Causes include salpingitis (inflammation of the fallopian tubes), peritubal adhesions, structural abnormalities of the fallopian tube, previous ectopic pregnancy, previous tubal surgery, tumors, IUD, progestin (only contraception), and pelvic inflammatory disease (PID)

• Clinical manifestations:

  • Delay in menses, slight bleeding, vague soreness or sharp colicky pain, GI symptoms, dizziness, lightheadedness

  • With tube rupture: agonizing pain, dizziness, faintness, nausea or vomiting, progression to shock

  • Later: generalized abdominal pain that radiates to shoulder

Assessment for patient with ectopic pregnancy?

• Menstrual pattern

• Pain: description and location; sharp, colicky; radiating to shoulder and neck

• Vital signs, level of consciousness, nature and amount of bleeding

• Coping

• Potential complications

  • Hemorrhage

  • Hemorrhagic shock

Nursing Interventions for patient with ectopic pregnancy

• Relieving pain

  • Preanesthetic medications

  • Postoperative analgesics administered liberally

• Early ambulation

• Coughing

• Deep breathing

• Supporting the grieving process

  • Listen to and support patient

  • Encourage patient’s partner to be a part of this process

• Monitoring and managing potential complications

  • Continuous monitoring (VS, LOC, amount of bleeding, I&O)

  • Bed rest

  • Hct, Hgb, and blood gases should be monitored

  • Blood transfusions when appropriate

  • Self-care and continuing care

    • Effect of future pregnancies

    • Preconception counseling recommended

What is perimenopause?

• The period before menopause that begins on average 4 years before the last menstrual period

• Characterized by marked hormonal fluctuations and irregular menstrual cycles

• Women often have varied beliefs about aging, and these must be considered when caring for and educating perimenopausal patients

What is menopause?

• Permanent physiologic cessation of menses associated with declining ovarian function

• Changes in menstruation

• Clinical manifestations

• Psychological considerations

• Medical management: HRT; risks and benefits

• Alternative therapy for hot flashes

What is a vulvovaginal infections?

• Common problem

• Vagina is normally protected by acid pH maintained, in part, by Lactobacillus acidophilus

• Vaginal epithelium is responsive to estrogen, which induces glycogen formation, which breaks down into lactic acid; therefore, decreased estrogen decreases acid production

• With perimenopause and menopause, decreased estrogen is related to vaginal and labial atrophy, and tissue is more susceptible to infection

• Types:

  • Vaginitis

  • Candidiasis

  • Bacterial vaginosis: Gardnerella vaginalis

  • Trichomonas vaginalis

What are the risk for vulvovaginal infections?

• Premenarche, perimenopause, menopause, low estrogen levels

• Pregnancy or oral contraceptives

• Poor hygiene

• Tight garments and synthetic clothing

• Frequent douching

• Antibiotics

• Allergies

• Diabetes

• Intercourse with infected partner, oral genital contact, HIV

What is the assessment of patient with a vulvovaginal infections?

• Examine as soon as possible after onset of symptoms

• Instruct patient not to douche before assessment

• History includes

  • Physical and chemical factors

  • Psychogenic factors

  • Medical conditions

  • Use of medications

  • Sexual activity and history

What are the nursing interventions for patient with a vulvovaginal infection?

• Sitz baths may help relieve discomfort

• Explanation of the cause of symptoms and methods to help prevent infections may help reduce anxiety

• Douching is usually avoided; however, therapeutic douching may be prescribed to reduce odors and remove excessive drainage

• Patient education includes handwashing, proper hygiene, preventive strategies, measures to reduce risk, information regarding medications, and information regarding self-examination

Pelvic Inflammatory Disease (PID)

• Inflammatory condition of the pelvic cavity that may begin with cervicitis and involve the uterus (endometritis), fallopian tubes (salpingitis), ovaries (oophoritis), pelvic peritoneum, or pelvic vascular system

• Gonorrheal and chlamydial organisms are common causes, but most cases are associated with more than one organism

• Short- and long-term consequences can occur

What are the nursing assessments for PID?

• Vaginal discharge

• Dyspareunia

• Lower abdominal pelvic pain, and tenderness that occurs after menses that may increase with voiding or with defecation

• Other symptoms

  • Fever, general malaise, anorexia, nausea, headache, and possibly vomiting

• Pelvic examination—intense tenderness may be noted on palpation of the uterus or movement of the cervix (cervical motion tenderness)

What is the treatment PID?

• Broad-spectrum antibiotics; Ceftriaxone, doxycycline, methonizone

• Treat sexual partner to prevent reinfection

• Analgesics for pain relief

• Adequate rest and nutrition

• Patient education: how to prevent reinfection

HIV and AIDS

• 25% living with HIV are women

• Counseled about safer sex and informed about the dangers of unprotected sex

• Because there is a riskbof perinatal transmission, decisions to conceive or to use contraception must be based on education, accurate information, and care

• Pregnant women are advised to have an HIV test. The use of antiretroviral agents by preganant

What are some structual disorders- of female anatomy?

• Fistulas of the vagina

• Pelvic organ prolapse

  • Cystocele

  • Rectocele

  • Enterocele

• Treatment

  • Surgical

  • Medical: pessaries, pelvic floor muscle training

Fistua (what is goal?)

• An abnormal opening between two internal hollow organs or between an internal hollow organ and the exterior of the body.

• Congenital but most common in developing countries due to obstructed labor complications

• Goal: eliminate the fistula and treat infection/ excoriation; surgery

Pelvic Organ Prolapse (risk factor & management)

• Weakening of the vaginal walls allowing the pelvic organs to descend and protrude into the vaginal canal

• Risk factors: age, parity-amount of times women have given birth to child (24 weeks & older) (particularly vaginal delivery), menopause, previous pelvic surgery, and possibly a genetic predisposition

• Management: Kegel exercises, pelvic floor PT

Endometriosis

• A benign lesion or lesions that contain endometrial tissue (similar to lining of uterus) found in the pelvic cavity outside the uterus

• A chronic disease affecting between 7% and 10% of women of reproductive age, occurring more frequently in women who have never had children

• Major cause of chronic pelvic pain and infertility

• Pharmacologic therapy: analgesic, prostaglandin inhibitors, hormone therapy, oral contraception

What are some malignant disorders of the female reproductive tract?

• Cervical, uterine (endometrium), vaginal, vulvar, fallopian tubes, and ovarian cancers

• Early disease may not have symptoms → Lower back pain can be a early indicator

• Signs and symptoms: depend on location; vaginal discharge, pain, bleeding, and systemic symptoms (weight loss and anemia)

• Prevention, screening, and early detection are vital

• Tx: Surgery, chemotherapy, radiation, or a combination of these

  • Treatment may be curative or palliative

  • Care of the surgical patient is similar to care of patients with other abdominal surgeries

What are some genital viral infections?

• Human papillomavirus (HPV)

  • The most common sexually transmitted disease amongsexually active young people

  • Vaccine -> usally given around age 11-13

  • Treatment of genital warts

  • Associated with cervical dysplasia and cervical cancer; need annual Pap smears

• Herpes type 2 infection (herpes genitalis)

  • A recurrent lifelong viral infection

  • An STD that also may be transmitted by contact and that may be transmitted when the carrier is symptomatic

  • Causes painful itching and burning herpetic lesions

What is hysterectomy?

• Surgical removal of the uterus to treat cancer, dysfunctional uterine bleeding, endometriosis, nonmalignant growths, persistent pain, pelvic relaxation and prolapse, and previous injury to the uterus

• Total hysterectomy

• Radical hysterectomy

• Types of approaches

  • Laparoscopic

  • Vaginal

  • Abdominal

Asessment + collaborative problems and potential complications of patient undergoing a hysterectomy

Assessment

• History

• Physical & pelvic exam

• Psychosocial & emotonal response

• Patient knowledge → educate on self care post op

Collaborative Problems & Potential Complications

• Hemorrhage

• DVT

• Bladder dysfunction

• Infection

Nursing Interventions for the patient undergoing a hysterectomy

• Relieving anxiety

  • Allow patient to express feelings

  • Explain physical preparations and procedures

• Improving body image

  • Listen and address concerns

  • Provide appropriate reassurance

  • Address sexual issues

  • Approach and evaluate each patient individually

• Relieving pain

  • Assess intensity of pain and administer analgesia as prescribed

  • Manage abdominal distension

• Monitoring for complications

  • Hemorrhage

  • Venous thromboembolism

  • Bladder dysfunction

• Educate about self-care and continuing care

  • Surgical incision care, maintaining bowel and urinary function, resuming activities slowly, showers instead of baths, activities to avoid, symptoms to report, follow-up

Radiation Therapy (in female reproductive tract)

• Used in the treatment of cervical, uterine, and less frequently in ovarian cancers

• Methods

  • External radiation therapy

  • Intraoperative radiation therapy

  • Internal (intracavitary irradiation)

• Care of the patient undergoing radiation therapy

What are some benign conditions of the breast?

• Breast pain (mastalgia)

• Cysts, fibrocystic breast changes

• Fibroadenomas

• Benign proliferative breast disease

  • Atypical hyperplasia

  • Lobular carcinoma in situ (LCIS)

• Other: cystosarcoma phillodes, fat necrosis, intraductal papilloma, superficial thrombophlebitis

What are some malignant conditions of the breast?

• Ductal carcinoma in situ (DCIS)

  • Proliferation of malignant cells inside the milk ducts without invasion into surrounding tissue

• Invasive cancer

  • Infiltrating ductal carcinoma: most common

  • Infiltrating lobular carcinoma

  • Medullary carcinoma: women <50 yrs old

  • Mucinous carcinoma: postmenopausal

  • Tubular ductal carcinoma

  • Inflammatory carcinoma

Breast Cancer

• Breast cancer is a major health problem in the United States. At present, there is no cure

• Over an entire lifetime, a woman’s risk of developing breast cancer is about 12% or one in eight

• Approximately 268,600 new cases of invasive breast cancer are diagnosed in women each year

• Risk of developing breast cancer increases with age

• Female breast cancer incidence rates vary substantially by race and ethnicity

  • Non-Hispanic African American women have higher incidence of breast cancer than non-Hispanic Caucasian women before the age of 40 and are more likely to die from breast cancer at every age

Diagnosing Breast Cancer

• Staging: TMN (tumor, nodes, metastasis)

• Chest x-ray, CT, MRI, PET, bone scan and blood work

• Prognosis

  • Tumor size

  • Spread to the lymph nodes?

  • Certain genes (ERBB2)

• Educate on how to perform breast exam

Surgical management of breast cancer

• Modified radical mastectomy

• Total mastectomy

• Breast conservation treatment

• Sentinel node biopsy and axillary lymph node dissection

• Potential complications of surgery

  • Lymphedema

  • Hematoma or seroma formation

  • Infection

  • Changes in sexual function

Preoperative Nursing Interventions for the Patient Undergoing Surgery for Breast Cancer

• Review and reinforce information on treatment options

• Prepare patient regarding what to expect before, during, and after surgery

• Inform patient regarding surgical drain, arm and shoulder mobility, and range-of-motion exercises

• Maintain open communications

• Provide patient with realistic expectations

• Support coping

• Involve or provide information for supportive services and resources

• Support patient decisions

Postoperative Nursing Interventions for the Patient Undergoing Surgery for Breast Cancer

• Relieve pain and discomfort

• Inform patient regarding common postoperative sensations

• Promote positive body image

• Maintain privacy

• Temporary breast form or soft padding for bra

• Provide information about home plan of care

• Support coping and adjustment; counseling and referral

• Monitor for potential complications

  • Lymphedema, hematoma or seroma, infection

• Don’t use bp cuff on same side bc can lead to lyphedema

How to educate patients on self care?

• Surgical site management and care of drain (drains are usually removed when the output is less than 30 mL in two consecutive 24-hour periods, approximately 7 to 10 days) → educate

• Shower on second postoperative day and wash the incision or drain site with soap and water. If immediate reconstruction has been performed, showering may be contraindicated until the drain is removed

• Patients are taught arm exercises on the affected side to perform three times a day for 20 minutes at a time until full range of motion is restored (generally 4 to 6 weeks)

• Heavy lifting (more than 5 to 10 pounds) is avoided for about 4 to 6 weeks

How to evaluate patient undergoing surgery for breast cancer?

• Exhibits knowledge about diagnosis and surgical treatment options

• Verbalizes willingness to deal with anxiety and fears

• Demonstrates ability to cope with diagnosis and treatment

• Reports that pain has decreased and identifies postoperative sensations

• Exhibits clean, dry, and intact surgical incisions

• Verbalizes feelings regarding change in body image

• Participates actively in self-care measures

What are the nonsurgical management of breast cancer?

• Radiation therapy—external beam, brachytherapy

• Chemotherapy

• Hormonal therapy

  • Estrogen and progesterone receptor assay

  • Selective estrogen receptor modulators (SERMs)— tamoxifen

  • Aromatase inhibitors—anastrazole, letrozole, exemestane

• Targeted therapy

Reconstructive procedures after mastectomy

• Tissue expander followed by permanent implant

• Tissue transfer procedures

  • Transverse rectus abdominal myocutaneous (TRAM) flap

• Nipple–areola reconstruction

• Prosthetics

• Reconstructive breast surgery: mammoplasty

  • Reduction, augmentation

  • Mastopexy

What are some special considerations of breast cancer?

• Implications of genetic testing: rapid advancement

• Pregnancy and breast cancer

• Breast cancer: quality of life and survivorship

• Gerontologic considerations

• Breast health of women with disabilities

• Diseases of the male breast

  • Gynecomastia

  • Male breast cancer

Male breast cancer?

• The lifetime risk of breast cancer in men is about 1 in 1000

• Early detection is uncommon in male breast cancer because of the rare nature of the disease

• Treatment: total mastectomy

• Stigma with such diagnosis, which may cause poor adherence to treatment plans

Disorders of male sexual function

• Erectile dysfunction

  • Psychogenic causes: anxiety, fatigue, depression, absence of desire

  • Organic causes: vascular, endocrine, hematologic, and neurologic disorders; trauma; alcohol; medications; and drug abuse

  • Medications associated with erectile dysfunction

• Ejaculation problems

  • Premature ejaculation

  • Retrograde ejaculation

What is the medical management of erectile dysfunction?

• Pharmacologic therapy

  • Oral medications—sildenafil (Viagra)

    • Side effects: headache, flushing, dyspepsia, diarrhea, nasal congestion, lightheadedness

    • Caution with retinopathy

    • Contraindicated with nitrate use

  • Injected vasoactive agents

    • Complications include priapism (persistent abnormal erection)

  • Urethral gel

• Penile implants and transplants

• Negative pressure devices

What is prostatitis?

• Prostatitis: inflammation caused by an infectious agent

  • Acute bacterial: sudden onset of fever, dysuria, perineal prostatic pain

  • Chronic bacterial: typically asymptomatic

  • Chronic prostatitis/chronic pelvic pain syndrome: genitourinary symptoms with no bacteria in urine

  • Asymptomatic inflammatory prostatitis: diagnosed incidentally, elevated PSA

• Treatment includes appropriate anti-infective agents and measures to alleviate pain and spasm

  • Trimethoprim-sulfamethoxazole or a fluoroquinolone (e.g., ciprofloxacin)

  • Alpha-adrenergic blocker therapy (e.g., tamsulosin; flomax) maybe prescribed to promote bladder and prostate relaxation

    • relax smooth muscle by blocking -1 receptors, reducing blood pressure, and increasing urine flow

What is BPH?

• Benign prostatic hyperplasia (BPH=enlarged prostate)

• Affects half of men older than 40 years of age and 50% of men older than 60 years of age

• Manifestations are those of urinary obstruction, urinary retention, and urinary tract infections

• Develops over a period of time; changes in urinary tract slow and insidious

• Symptoms depend on severity: dysuria, hesitancy, sensation of incomplete bladder emptying

How is BPH treated?

• Medical treatment

  • Alpha-adrenergic blockers#

  • 5-alpha-reductase inhibitors

  • Measures to reduce pain and spasms

  • Catheter for acute condition; unable to void

• Surgical treatment

  • Minimal invasive therapy

    • Transurethral microwave thermotherapy

    • transurethral needle ablation by radiofrequency energy and insertion of a stent

  • Surgical resection

  • Transurethral resection of the prostate (TURP)

Prostate Cancer (Manifestations, treatment)

• Second most common cancer and the second most common cause of cancer death in men

• Risk factors include increasing age, familial predisposition, and African American race

• Manifestations:

  • Early disease has few or no symptoms

  • Symptoms of urinary obstruction, blood in urine or semen, painful ejaculation

  • Symptoms of metastasis may be the first manifestations

• Treatment may include therapeutic vaccine, prostatectomy, radiation therapy, hormonal therapy, or chemotherapy

What is surgical approaches to prostatectomy?

• Transurethral resection of the prostate (TURP)

• Suprapubic prostatectomy

• Perineal prostatectomy

• Retropubic prostatectomy

• Transuretheral incision of the prostate

• Laparoscopic radical prostatectomy

• Robotic-assisted laparopscopic radical prostatectomy

• Pelvic lymph node dissection

What are the disorders affecting the testes and adjacent structures? * don’t focus on

• Orchitis: an acute inflammation of one or both testes as a complication of systemic infection or as an extension of an associated epididymitis caused by bacterial, viral, spirochetal, or parasitic organisms.

• Epididymitis: an infection of the epididymis, which usually spreads from an infected urethra, bladder, or prostate

• Testicular torsion: a surgical emergency requiring immediate diagnosis to avoid loss of the testicle

• Testicular cancer

Testicular cancer (manifestations)

• Most common cancer in men ages 15 to 40 years

• Highly treatable and curable

• Risk factors: undescended testicles, positive family history, cancer of one testicle, Caucasian American race

• Manifestations: painless lump or mass in the testes

• Early diagnosis: monthly testicular self-exam (TSE) and annual testicular exam

• Treatment: orchidectomy, retroperitoneal lymph node dissection (open or laparoscopic), radiation therapy, chemotherapy

What are some conditions affecting the penis? * don’t focus on

• Phimosis: a condition in which the prepuce (foreskin) cannot be retracted over the glans in uncircumcised males

• Penile cancer

  • Bowen disease

• Priapism: a persistent penile erection that may or may not be related to sexual stimulation

• Peyronie’s disease: an acquired, benign condition that involves the buildup of fibrous plaques in the sheath of the corpus cavernosum

• Urethral stricture: a condition in which a section of the urethra is narrowed

• Circumcision: surgical excision of the prepuce (foreskin) of the glans penis

What are some heath risks in in LGBTQ?

• 4.5% of U.S. population are gay

• Stigmatization

• Higher rate of: depression, anxiety, and suicide

• Victimization: leads to emotional distress

• HIV: higher rates in men who are gay or bisexual and transgender women

Define sex & gender?

• Sex: physical or biologic characteristics that distinguish women and men

  • Chromosomes, genitals, hormones

  • Assigned at birth for most

  • Intersex: born with biologic traits not traditionally characterized as either male or female

• Gender: a set of socially constructed characteristics of women and men

  • Voice, communication style, hairstyle, clothing, mannerisms

  • Taught norms and behaviors

  • Vary based on society; can be changed

What is inclusive language to use?

• Sexual identity

• Gender identity

• Accurate information

• Open to listening

• Neutral language

• Avoid assumptions

• Confirm preferences

Health History & Physical Assessment

• Family structure

• Open-ended questions

• Mirror language used by the patient

• No specific assessments or diagnostic tests

• Older LGBTQ patients

Gender Reassignment

• Gender dysphoria

  • DSM criteria: Chart 54-2

• Interdisciplinary health care team

• Hormone therapy

  • Feminizing (male to female)

  • Masculinizing (female to male)

What is the surgical management/ criteria for gender reassignment surgery?

• Criteria for gender reassignment surgery

  • Documented gender dysphoria

  • Age of consent

  • Need to get consent

  • 12 months hormone therapy

  • 12 months living in the gender role

How is patient undergoing gender reassignment surgery assessed?

• Ensure the patient and their family feel welcomed and safe.

• Use gender-neutral language and properly assess for gender identity and pronouns

• Preoperative education and counseling

  • Risks and benefits, complications, postoperative outcomes, need for follow-up

• Surgery-specific assessments

What are the nursing interventions done for patients undergoing gender reassignment surgery?

• Ensuring human dignity

• Reducing anxiety

• Relieving pain

• Preventing and monitoring for infection

• Promoting hope

• Monitoring and managing potential complications

  • Hemorrhage

  • Venous thromboembolism

  • Tissue necrosis

• Patient education