Vaginal Douching and Pre-menstrual Syndrome Lecture Notes

A complete set of practice flashcards covering Vaginal Douching and Pre-menstrual Syndrome (PMS) based on the lecture transcript.

What is the definition of vaginal douching?

The process of rinsing or cleaning the vagina by forcing water or another solution into the vaginal cavity to flush away vaginal discharge or other contents.

Why is douching after sexual intercourse considered ineffective?

It is not effective for avoiding pregnancy or sexually transmitted diseases.

What should women with an unusual vaginal odor do instead of douching?

They should seek medical advice, as using a douche may only intensify the problem.

Under what specific condition should medicated vaginal douching be performed for chronic yeast or bacterial infections?

It should be done only under a doctor’s supervision.

What are the two primary methods of vaginal douching?

The bulb douche syringe method and the douche bag method.

How far should the nozzle be inserted into the vagina during the bulb douche syringe method?

About $3’’$ into the vagina.

Is vaginal douching generally recommended by medical experts?

No, studies have not shown douching to be safe or desirable, and it is associated with adverse events.

What characterizes the self-cleansing environment produced by the vagina?

It contains a complex mix of micro-organisms, proteins, mucus, and fluid that produces an acidic, self-cleansing environment.

How does douching increase the risk of vaginal infection?

It disrupts vaginal flora and $pH$, leading to an overgrowth of anaerobes.

List at least five potential adverse effects associated with vaginal douching.

Local irritation, pelvic inflammatory disease ($PID$), preterm delivery, ectopic pregnancy, reduced fertility, and cervical cancer.

What alternative cleansing method is suggested for routine hygiene instead of douching?

Washing the vagina gently with fingers using lukewarm water and mild soap.

When is vaginal douching strictly contraindicated?

During pregnancy.

What is the maximum frequency for douching if a patient insists on it?

Not more often than $2 \times$ a week, unless instructed by a doctor.

How long should a person wait after a gynecologic examination before douching?

$48$ hours.

If a vaginal antifungal medication was used, how long must a patient wait before douching?

At least $3$ days after the last dose.

How long should a patient wait after sexual intercourse involving a vaginal spermicide before douching?

At least $6-8$ hours.

What is the average duration of the menstrual cycle?

$28$ days, though it can vary from $21$ to $40$ days.

Which three entities make up the hypothalamic-pituitary-ovarian axis?

The hypothalamus, pituitary gland, and ovary.

What occur during the Menstrual phase (Day $1-4$)?

Low levels of estradiol and progesterone cause the uterus to shed its lining and the egg.

Which phase occurs from Day $5$ to Day $14$ of the menstrual cycle?

The Proliferative or Follicular phase.

Which phase occurs from Day $14$ to Day $28$ of the menstrual cycle?

The Secretory or Luteal phase.

What is the role of FSH at the end of a previous menstrual cycle?

It stimulates the growth and maturation of a group of ovarian follicles.

What event occurs during the Follicular phase due to an LH surge?

Ovulation.

What does the corpus luteum secrete during the Luteal phase?

Progesterone, estradiol, and androgens.

If implantation does not occur, what does the corpus luteum become?

It involutes to form the corpus albicans.

How is Pre-Menstrual Syndrome ($PMS$) defined?

A cyclic disorder composed of physical and emotional changes that occur during the luteal phase and improve significantly within the first few days of menstrual flow.

What percentage of women experience some physical or mood changes before the onset of menses?

$> 80(\%)$ of women.

What neurotransmitter decrease is linked to irritability and food cravings in $PMS$?

Serotonin.

What are the symptoms of Premenstrual dysphoric disorder ($PMDD$)?

Physical and mood-related symptoms that seriously disrupt a woman’s life and relationships.

What is the typical symptom-free interval during the menstrual cycle for someone with $PMS$?

Days $4-12$ of the menstrual cycle.

What are the two primary treatment goals for $PMS$?

Understanding of $PMS$ and symptom improvement or resolution.

What are recommended dietary modifications for $PMS$?

Avoid salty foods, simple sugars, caffeine, and alcohol; consume foods high in carbohydrates and low in protein.

What is the maximum daily dose of Pyridoxine (Vitamin $B_6$) for $PMS$?

$100’mg$ daily.

What are the symptoms of Pyridoxine (Vitamin $B_6$) toxicity?

Paresthesia, bone pain, and muscle weakness.

What is the recommended dose of Vitamin E for breast tenderness?

$400’IU$ daily.

What is the recommended dose for Calcium for treating $PMS$?

$600’mg$ twice daily.

Which symptoms are specifically reduced by Calcium therapy in $PMS$?

Emotional symptoms (mood swings, depression, anger), behavioral symptoms (food cravings), and physical symptoms (fluid retention, breast tenderness, backaches, abdominal cramping).

What is the recommended dose of Magnesium during the luteal phase?

$360’mg$ daily.

What is the most common side effect of Magnesium supplements?

Diarrhoea.

Which NSAIDs are mentioned for the treatment of physical and mood symptoms in $PMS$?

Ibuprofen and Naproxen Sodium.

What non-prescription diuretics are used to relieve fluid retention in menstrual products?

Caffeine and Pamabrom.

What is the safe and effective dose of Caffeine when used as a diuretic for menstrual symptoms?

$100-200’mg$ every $3-4$ hours.

What are the side effects of excessive Caffeine intake?

Anxiety, restlessness, insomnia, irritability, and tachycardia.

What is the maximum daily dose of Pamabrom?

Up to $200’mg$ per day.

Which supplements are considered initial treatment for $PMS$?

Calcium, magnesium, or pyridoxine.

For which specific symptom are Caffeine or Pamabrom recommended?

Bloating.

Why is Caffeine not a good choice for women who experience irritability during $PMS$?

It can cause side effects like anxiety, restlessness, and increased irritability.

Name three contraindications for the use of Caffeine and Pamabrom.

History of peptic ulcer disease, taking monoamine oxidase inhibitors, or taking other xanthine medications (e.g., theophylline).

For which patients are NSAIDs reserved in the context of $PMS$?

Women who experience both $PMS$ and dysmenorrhea.

What biochemical trigger initiates the FSH response at the end of a cycle?

Low levels of estradiol and progesterone.