FEMALE REPRODUCTIVE DISORDERS

What is a contraception?

The intentional prevention of pregnancy using devices, agents, drugs, sexual practices, and surgical interventions.

What are the most effective contraceptive methods?

Abstinence, male and female sterilization, intrauterine contraception, and implanted devices.

What are considered very effective contraceptive methods?

Injectable contraceptives, patches, rings, and pills.

What are considered less effective contraceptive methods?

Male and female condoms, diaphragm, and fertility awareness methods.

Are most contraceptive methods reversible or permanent?

Most methods are reversible; sterilization (tubal ligation, vasectomy) is considered permanent, though failures/reversals can occur.

What factors should be considered when counseling a patient on contraceptive choice?

Safety, protection from STIs, effectiveness, acceptability, convenience, benefits, side effects, effect on spontaneity, availability, expense, preference, religious/personal beliefs, and informed consent.

What happens to the fallopian tubes during a tubal ligation?

They are banded, cauterized, cut, or tied.

What happens during a vasectomy?

The vas deferens is cut, preventing sperm from being released.

Are tubal ligation and vasectomy guaranteed to be permanent?

No — failures can occur (e.g., a clip not holding, tubes reconnecting), and reversal surgery is difficult, expensive, and sometimes unsuccessful.

How is sterility confirmed after a vasectomy?

Semen analysis 8 to 16 weeks after, until two specimens show no sperm present.

Do fertility awareness-based methods protect against STIs?

No — they don't use a barrier method, so they offer no STI protection, and they require good cooperation from the male partner.

What is the failure rate of the withdrawal (coitus interruptus) method, and why is it not very reliable?

About 18-20% failure rate; pre-ejaculatory semen can contain a high sperm count even without full ejaculation inside.

What is the lactational amenorrhea method (LAM), and how does it work?

A breastfeeding-based contraceptive method; breastfeeding stimulates prolactin, which inhibits gonadotropin release needed for ovulation.

How effective and reliable is LAM?

Fairly effective for up to 6 months after giving birth, but not foolproof.

What is the basal body temperature method?

A woman determines her most fertile days are usually 2-3 days before an increase in her body temperature, tracked daily.

Which days of the menstrual cycle should typically be avoided with natural family planning to prevent pregnancy?

Approximately days 8-19 of the cycle, since this is when ovulation is most likely.

What happens to cervical mucus when a woman is ovulating?

It increases.

What are the advantages and disadvantages of natural/behavioral family planning methods?

Advantages: inexpensive since nothing is purchased. Disadvantages: requires a lot of discipline and organization, and typically a very regular cycle.

What are examples of barrier contraceptive methods?

Male condom, female condom, sponge, diaphragm, and cervical cap.

What are chemical barrier contraceptives, and how should they be used?

Spermicides (creams, gels, foams); must be applied before intercourse and left in place for at least 15 minutes but not more than an hour.

How does a cervical cap differ from a diaphragm?

It is smaller than a diaphragm and must be fitted by a healthcare provider.

What are the pros of the birth control sponge?

Inexpensive, does not hinder future fertility, and does not contain hormones.

What are the cons of the birth control sponge?

Less effective at preventing pregnancy than other methods, and does not protect against STIs since only the interior is covered while the exterior remains exposed.

What are the benefits of hormonal contraceptives?

Highly effective at preventing pregnancy; can decrease cramps and bleeding, decrease anemia incidence, decrease risk of ectopic pregnancy/pelvic infection/benign breast disease, offer some protection from uterine and ovarian cancer, and promote a regular cycle.

What are the risks of hormonal contraceptives?

Breakthrough bleeding, tenderness, weight changes, nausea/vomiting, mood changes, possible increased liver tumors and gallbladder disorders, no STI protection, and increased risk of blood clots, stroke, and heart attack.

What are the main types of hormonal contraceptives?

Oral contraceptives, vaginal ring, patch, hormonal injections, long-acting reversible contraceptives (implant, IUD), and emergency contraception.

What are the types of oral contraceptive pills?

An estrogen pill, a progesterone pill, or a combination of both.

What is a POP, and what is it also called?

A progesterone-only pill, also called a 'mini pill.'

What key teaching point applies to taking oral contraceptives?

Take the pill at the same time every day and be consistent — don't miss a day; be aware it may interact with other medications.

What should a woman do if she misses one pill?

Take the one active pill as soon as she remembers.

What should a woman do if she misses two or more pills in the first two weeks of her pack?

Take her two pills and use an extra/backup contraceptive method.

What should a woman do if she misses more than 2 pills in the last week of her pack?

Wait and start a new pack of pills at her next cycle, using backup contraception until then.

What postpartum/lactation precaution applies to oral contraceptives?

Avoid oral contraceptives for 3 to 6 weeks postpartum (increased VTE risk); breastfeeding mothers should use progestin-only pills, which won't affect milk supply.

Which oral contraceptive side effects need to be reported to the HCP?

Abdominal pain, chest pain or shortness of breath, headaches, eye problems, and severe leg pain.

What is Depo-Provera, and how is it administered?

A progesterone-only IM injection that usually lasts for 3 months.

How does Depo-Provera work?

It thickens cervical mucus, makes the endometrial lining unfavorable for implantation, and suppresses ovulation.

What are the side effects of Depo-Provera?

Menstrual cycle disturbances, depression, acne, weight gain, and loss of bone mineral density.

How long can it take for a woman's cycle to fully return after stopping Depo-Provera?

Up to 9 months after the last injection.

How is a contraceptive patch typically worn?

Worn for 3 weeks, then removed for the 4th week.

What is a downside of the contraceptive patch for women who are overweight/obese (around 200 lbs or more)?

Decreased effectiveness, along with increased risk of cardiovascular concerns and weight gain.

What lifestyle factor can reduce contraceptive patch effectiveness?

Heavy sweating can cause the patch to fall off, requiring frequent replacement.

How is a vaginal ring (e.g., NuvaRing) typically used?

Inserted for 3 to 4 weeks, then removed for the 4th week.

What are potential side effects/issues with the vaginal ring?

Erosion of the vaginal wall, increased vaginal discharge, interference with intercourse, and vaginal discomfort.

What is a Nexplanon implant, and how long does it protect against pregnancy?

An implanted device that delivers 3 years of continued pregnancy protection.

How does the Nexplanon implant work?

It inhibits ovulation and thickens cervical mucus.

How is Nexplanon inserted, and does it protect against STIs?

It is a minor surgical procedure done in the clinician's office; it does NOT provide STI protection.

What are side effects of Nexplanon?

Irregular bleeding, headaches, weight gain, increased appetite, breast tenderness, depression, and possible peripheral nerve injury/site irritation.

What is an IUD, and how does it work?

A device implanted in the uterus that inhibits sperm-ova meeting and inhibits endometrial implantation; can be copper- or progesterone-based.

How long can an IUD provide contraceptive protection?

5 to sometimes up to 10 years, depending on the device.

What symptoms should a woman with an IUD report to her HCP?

Significant pain, infection exposure, not feeling well, fever, chills, or flu-like symptoms.

Does an IUD protect against STIs?

No — it is very effective against pregnancy, but does not protect against STIs.

What is emergency contraception used for?

Reducing the risk of pregnancy after unprotected intercourse, within a small window of time.

Does timing matter with emergency contraception?

Yes — the sooner it is taken, the more effective it is.

Does emergency contraception protect against STIs?

No.

Should emergency contraception be used as a regular form of birth control?

No.

What should a woman do if her menses does not occur within 3 weeks after using emergency contraception?

Check for pregnancy.

What symptom after taking emergency contraception should be reported to the HCP?

Any severe abdominal pain.

Is emergency contraception safe to use if a woman is already pregnant?

No — it is contraindicated if pregnant.

Is Plan B considered a form of abortion?

No — it prevents fertilization; it is not an abortion pill.

Is Plan B available over-the-counter?

Yes.

What is an STI?

An infection in the reproductive tract caused by pathogens transmitted through vaginal, anal, or oral sexual intercourse.

Who is at greater risk and experiences more complications from STIs — males or females — and why?

Females — due to anatomy, there is more space for infection to occur.

What complications can STIs contribute to?

Cervical cancer, infertility, ectopic pregnancy, chronic pelvic pain, complications for the fetus/newborn, and death.

What percentage of all STIs occur among people ages 15-24?

46%.

What percentage of high school students report being sexually active, and how many use protection?

30% report being sexually active; less than half of those use condoms or another form of contraception.

Which group has a higher reported rate of STIs than any other ethnic or racial group among females?

Black females.

Is there a higher prevalence of STIs among transgender and non-binary people compared to the general population?

Yes.

Why are adolescents considered a high-risk population for STIs?

Largely due to a lack of knowledge/knowledge deficit.

What nursing approach is recommended when caring for high-risk STI populations?

Provide open dialogue and a non-judgmental approach, work with the healthcare team to ensure access to care, and assess for high-risk behaviors, educating and counseling on STI risk reduction.

Do all STIs need to be reported to public health authorities?

No — only specific STIs must be reported, not all of them.

What confidentiality principle applies when caring for a patient with an STI?

Ensure patient confidentiality — do not share the patient's information, including their name, with anyone else.

Why is it important to adapt STI education to a patient's developmental level?

To make sure the patient understands the information, based on their existing knowledge of their body, sex, and reproductive organs.

What are typical symptoms of chlamydia?

Often asymptomatic; may include increased purulent (thicker) vaginal discharge, urethritis, and dysfunctional uterine bleeding.

How is chlamydia diagnosed?

Vaginal swab or urine sample.

How is chlamydia treated in a non-pregnant patient?

Doxycycline for 7 days.

How is chlamydia treated in a pregnant patient?

Azithromycin (Zithromax).

Why should a pregnancy test be done when testing a woman for chlamydia?

To determine the appropriate treatment, since treatment differs for pregnant versus non-pregnant patients.

What percentage of gonorrhea cases are asymptomatic?

70%.

What are symptoms of gonorrhea when present?

Mucopurulent vaginal discharge, dysuria, abnormal vaginal bleeding, and abdominal/pelvic pain.

How is gonorrhea diagnosed?

Urine sample or vaginal swab.

How is gonorrhea treated?

A single IM dose of Rocephin (ceftriaxone).

What is the main visible symptom of genital herpes?

Painful vesicular lesions on the perineal area.

What other symptoms can occur with genital herpes?

Increased vaginal discharge, fever, chills, malaise, dysuria, and genital irritation.

How is genital herpes diagnosed?

Visual inspection of lesions, viral culture, PCR, and clinical signs.

Is there a cure for genital herpes?

No — the virus stays dormant in the body for life and can still be transmitted to others even without an active outbreak.

What medications help manage genital herpes outbreaks?

Antivirals such as acyclovir and valacyclovir (Valtrex) — they reduce recurrences, improve symptoms, and decrease the risk of transmission.

Must syphilis be reported to public health authorities?

Yes.

What characterizes a primary syphilis infection?

A painless ulcer (chancre) at the site of entry.

What characterizes a secondary syphilis infection?

Flu-like symptoms and a rash on the palms of the hands, soles of the feet, and trunk of the body.

What characterizes a tertiary syphilis infection?

Absence of clinical symptoms.

How is syphilis diagnosed?

RPR serology test and VDRL test.

How is syphilis treated?

Penicillin.

What is another name for HPV?

Genital warts.

How is HPV diagnosed?

Visual inspection for genital warts, a Pap smear, and/or an HPV test.

What does treatment for HPV focus on, and is there a cure?

Removing the warts; there is no cure for HPV.

What is the best current prevention for HPV?

The HPV vaccine, given during adolescence.

Why is HPV a significant health concern beyond genital warts?

It can lead to cancer, so prevention and wart removal are prioritized.

How are scabies/lice typically transmitted?

Through close contact with an infected person.

What do scabies/lice cause?

Intense itching, from parasites burrowing under the skin (lice can also affect the pubic area).

How is scabies/lice diagnosed?

Based on history and clinical findings.