Nur 319 Ch 27: Female Genitourinary System Abnormals

Pediculosis Pubis

Severe perineal itching; Excoriations and erythematous areas. May see little dark spots (lice are small), nits (eggs) or lice; Usually localized in pubic hair, occasionally in eyebrows or eyelashes. Transmission usually sexual contact though may be contaminated clothing, bedding.

Herpes Simplex Virus Type 2 (Herpes Genitalis)

S: Episodes of local pain, dysuria, fever, headache, malaise, or asymptomatic.

 O: Presents as clusters of small, shallow vesicles with surrounding erythema; erupts on genital areas and inner thigh, usually bilaterally. Also, inguinal adenopathy, edema. Progresses through short-lived vesicles (1–3 days), painful ulcers, crusts (2–3 weeks). The virus remains dormant and can reoccur.

Syphilitic Chancre

STI that begins as a small, solitary silvery papule that erodes to a red, round or oval, superficial ulcer with a yellowish serous discharge; Nontender indurated base; can be lifted like a button between thumb and finger. Nontender inguinal lymphadenopathy; secondary syphilis follows: fever, lymphadenopathy, mucocutaneous red rash, sore throat.

Red Rash- Contact Dermatitis

S- history of skin contact with allergen (feminine hygiene spray or synthetic underclothing), intense pruritus

O- Primary lesion—Red, swollen vesicles. Then may have weeping of lesions, crusts, scales, thickening of skin, excoriations from scratching.

Human Papillomavirus (Genital Warts)

painless warty growths; Pink or flesh-colored, soft, pointed, moist, warty papules. Single or multiple in a cauliflower-like patch; Treated with topical medication or surgical removal. Abstain from sex while warts are present.

Abcess of Bartholin Gland

local pain; Overlying skin red, shiny, and hot. Posterior part of labia swollen; palpable fluctuant mass and tenderness. Requires incision and drainage, antibiotic therapy.

Urethritis and UTI

S – inflamed urethra, UTI, dysuria, frequency, urgency, flank or suprapubic pain. Older adults may only have communication problems, confusion, and lethargy

O – anterior vaginal wall erythema, urethral pain, maybe purulent discharge; UTI diagnosed with urine culture

Urethral Caruncle

S – tender, pain with urination, frequency, hematuria, dyspareunia (painful intercourse)

O – small red benign mass protruding from meatus. Lesion may bleed on contact. More common in postmenopausal women

Cystolcele

S – feeling pressure in vagina, stress incontinence

O – presence of soft round anterior bulge when straining. Bladder prolapses into vagina. Bladder

Uterine Prolapse

With straining or standing, uterus protrudes into vagina. Nontender, nonfluctuant, smooth hemisphere; may cause a broad-based gait.

Rectocele

S - Feeling of pressure in vagina, possibly constipation.

O - With straining, note introitus widening and the presence of a soft, round bulge from posterior. Rectum 

Atrophic Vaginitis

S – postmenopausal vaginal itching, dryness, burning sensation, dyspareunia (painful sex), mucoid discharge, postcoital bleeding, symptoms occur gradually due to thinning of epithelial layers

O – pale, dry mucosa with abraded areas that bleed easily, decreased rugae, bloody discharge. Decrease in usual shiny vaginal secretions. Vagina may be shortened and narrowed. Cervix may be less protuberant. Loss of estrogen created signs and increases risk for trauma and infection

Candidiasis (moniliasis)

intense pruritus; thick, whitish, clumpy discharge; O – vulva and vagina are erythematous and edematous. Discharge usually thick, white, and curdy like cottage cheese, not malodorous; Causes – recent use of antibiotics, some oral contraceptives, uncontrolled or undiagnosed diabetes, wearing tight or nylon underwear, pregnancy with increased glycogen, more alkaline vaginal pH, postpartum, or menopause

Trichomoniasis

S – pruritus, watery often malodorous discharge, urinary frequency, terminal dysuria. Symptoms are worse during menstruation

O – vulva may be erythematous. Vagina diffusely red, granular, occasionally red, raised papules and petechiae. Frothy, yellow-green, foul-smelling discharge. STI Vaginal pH >4.5 

Bacterial Vaginosis

foul smelling discharge and “fish” smell coming from vagina. No inflammation of vaginal wall or cervix. NOT STI Vaginal pH > 4.5

Chlamydia

Very minimal symptoms. Most common signs and symptoms are dysuria, frequency, yellow or green vaginal discharge, cervical tenderness. Can later become PID (Pelvic Inflammatory Disease) and cause infertility. STI. Tested by urine

Gonorrhea

95% of cases are asymptomatic; Must retest again in 3-6 months. May progress to salpingitis (inflammation of fallopian tubes) or PID (Pelvic Inflammatory Disease). Signs and symptoms include purulent discharge, bloody urine, and abscess in Bartholin or Skene glands.

Pregnancy

Amenorrhea, fatigue, breast engorgement, nausea, change in food tolerance, and weight gain; Cyanosis of vaginal mucosa and cervix (Chadwick sign). Palpation—Soft consistency of cervix, enlarging uterus with compressible fundus and isthmus

Myomas

Myomas are estrogen dependent; after menopause the lesions regress but do not disappear; vague discomfort, bloating, heaviness, pelvic pressure, dyspareunia, urinary frequency, and backache; Uterus irregularly enlarged; firm; mobile; and nodular with hard, painless nodules in the uterine wall. Heavy bleeding produces anemia. Confirmed by ultrasound imaging.

Carcinoma of the Endometrium

S: Abnormal and intermenstrual bleeding before menopause. Pain and weight loss occur late in the disease.

 O: Uterus may be enlarged \n Risk factors are early menarche, late menopause, history of infertility, failure to ovulate, tamoxifen, unopposed estrogen therapy

Endometriosis

S: Cyclic or chronic pelvic pain, occurring as dysmenorrhea (menstural cramps) or dyspareunia (painful sex), low backache. May have irregular uterine bleeding, hypermenorrhea, or be asymptomatic.

 O: Uterus fixed, tender to movement. Ovaries often enlarged; Masses are aberrant growths of endometrial tissue scattered throughout pelvis, May cause infertility from pelvic adhesions, tubal obstruction, decreased ovarian function.

Acute Salpingitis

S: Sudden fever >38° C or 100.4° F, suprapubic pain and tenderness. O: Acute—Rigid, boardlike lower abdominal musculature. May have purulent discharge from cervix.Chronic—Bilateral, tender, fixed adnexal masses; Complications include ectopic pregnancy, infertility, and reinfection.

Ectopic Pregnancy

S: Sharp, stabbing abdominal or pelvic pain, vaginal spotting or new-onset bleeding

O: Softening of cervix and fundus; movement of cervix and uterus cause pain; palpable tender, round, mobile swelling, lateral to uterus. This is leading cause of first-trimester pregnancy-related death. EMERGENCY

Ovarian Cyst

S: Usually asymptomatic; when cyst is large, can be painful; may have dyspareunia.

O: Bimanual palpation shows smooth, round, fluctuant, mobile, nontender mass on ovary. Most resolve on their own, with follow-up at 2 to 3 months.

Ovarian Cancer

S: Vague symptoms; may have abdominal pain, pelvic pain, increased abdominal size, bloating, difficulty eating, red spotting, or may be asymptomatic.

O: heavy, solid, fixed, poorly defined mass that suggests malignancy; biopsy necessary to distinguish

Polycystic Ovary Syndrome

Amenorrhea for 3 months or infrequent menses, infertility, hyperandrogenism (acne, hirsutism, hair loss), weight gain; May also have insulin resistance and diabetes. May be treated with metformin, hormonal regulation of menses, and infertility specialists.

Ambiguous Genitalia

congenital anomaly resulting from hyperplasia of the adrenal glands, which exposes the female fetus to excess amounts of androgens. the enlarged clitoris may look like a small penis with hypospadias and the fused labia look like an incompletely formed scrotum with absent testes.

Vulvovaginitis in Child

Acute nonspecific, causes include infection from a respiratory or bowel pathogen, STI, presence of a foreign body, or Candida albicans in a child with diabetes.