Female Reproductive Health

what is vaginitis?

Inflammation characterized by vaginal discharge, burning and swelling, pain with urination or sexual intercourse

what are causes of vaginitis?

Infection, chemicals, foreign bodies

what causes pre-menarche vaginitis?

Hygiene, parasites, foreign bodies

what causes childbearing vaginitis?

Candida and Trichomonas

what causes menopause vaginitis?

Decreased estrogen causing atrophic changes

what causes cancer of the vagina?

May also be due to cervical cancer with extension, HPV — rare (1%)

what are manifestations of cancer of the vagina?

Abnormal bleeding, discharge, mass (mostly asymptomatic)

dianosed with a biopsy

what is cervictis?

Acute or chronic inflammation; Direct infection or secondary to vaginal/uterine infection

what is acute cervicitis?

• Clinical manifestations—Cervix reddened, edematous, mucopurulent drainage

• Treatment—Antibiotics

what is chronic cervicitis?

Low-grade inflammation due to small lacerations (trauma, childbirth)

• manifestations: Cervical os distorted, mucopurulent drainage, cysts

• tx: surgery cauterization

what is cancer of the cervix?

Easily detected cancer and if detected early, most curable of female reproductive cancers

who is at risk of cancer of the cervix?

Early age at first intercourse, multiple partners, smoking, history of STIs (HPV and genital warts)

what are manifestations of cancer of the cervix?

Abnormal vaginal bleeding, spotting, discharge

• More advanced—Pelvic or back pain, hematuria, fistulas

how is cancer of the cervix diagnosed?

pap smear, biopst

tx: removal of lesion, surgery, radiation

what is endometritis?

Inflammation of the endometrium; Can follow abortion, delivery, instrumentation

what is chronic endometritis?

Due to intrauterine devices, pelvic inflammatory disease, retained conceptus

what are manifestations of endometritis?

Abnormal vaginal bleeding, uterine tenderness, fever, foul-smelling discharge

tx: antibiotics

dx: presence of plasma cells

what is endometriosis?

Functional endometrial tissue found in sites outside the uterus; cause is unknown

what are manifestations of endometriosis?

Becomes active when reproductive hormones stimulate the tissue

• Pelvic pain occurs pre-menstrually and ends after menstruation

• Infertility can result

how is endometriosis treated?

• Pain relief—NSAIDs

• Endometrial suppression—Oral contraceptives

• Surgery with larger endometriomas, cautery, ablation, hysterectomy

what is endometrial cancer?

most common cancer of the female pelvis, average age is older than 60

what is type I endometrial cancer?

Prolonged estrogen stimulation and endometrial hyperplasia in perimenopausal women (85%)

what are risk factors of type I endometrial cancer?

Diabetes mellitus, hypertension, obesity, polycystic ovary syndrome

what is type II endometrial cancer?

Post-menopausal with endometrial atrophy, older women

what are manifestations of type II endometrial cancer?

Abnormal painless bleeding; later cramping, pelvic discomfort

how is type II endometrial cancer treated?

• Surgery, radiation

• Early diagnosis has a 96% five-year survival rate

what is pelvic inflammatory disease (PID)?

Affects the upper reproductive tract—Inflammatory—Infection ascends through uterus to fallopian tubes and ovary d/t sexually transmitted diseases or other infections

what are the risk factors of PID?

Age 16–24, multiple sexual partners, previous PID

what are manifestations of PID?

• Pain in lower abdomen, back and cervix

• Purulent discharge, adnexal (in the area of the uterus) tenderness

• Fever > 101

tx: IV antibiotics

what can happen after PID?

Can result in infertility, ectopic pregnancy, adhesions, abscess

what are ovarian cysts?

Most common cause of enlarged ovaries (fluid-filled)

• Discomfort on the affected side if enlarged or bleeding

what is polycystic ovary syndrome?

Common endocrine disorder

• Causes chronic anovulation

• Amenorrhea or irregular menses

what does polycystic ovary syndrome stimulate?

androgen production—Acne, hirsutism, infertility

how is polycystic ovary syndrome treated?

Symptom relief, reduce diabetes and cardiovascular disease development

what is ovarian cancer?

often deadly since it is difficult to diagnose

what are risk factors of ovarian cancer?

• Ovulatory age—Most significant risk factor (amount of time when ovarian cycle is not suppressed—more time is higher risk)

• Family history, BRCA1 and BRCA2 increase susceptibility

• High-fat diet and genital talc powders linked

what is the clinical presentation of ovarian cancer?

Causes vague GI symptoms, abdominal and pelvic pain, bloating, feeling full after eating

how is ovarian cancer prevented?

Long-term oral contraceptive use may be useful, surgical removal of ovaries and fallopian tubes

tx: surgery, chemo

what is Dysfunctional Menstrual Cycles?

Typically related to dysfunctional bleeding (hormone-related)

what is Abnormal Uterine Bleeding?

Any bleeding outside of normal menstruation

what is Amenorrhea?

Absence of menstruation

• Primary—Failure to menstruate by 15 (or 13 with no secondary sex characteristics)

• Secondary—Cessation of menstruation for six months

what is Dysmenorrhea?

Pain or discomfort during menstruation producing disability

• Primary—Excess prostaglandin production causing smooth muscle stimulation

• Secondary—Structural or disease process (endometriosis, fibroids, PID)

what is premenstrual syndrome?

Physical, emotional, and behavioral changes

• Variable symptoms—Mild to severe

what are manifestations of premenstrual syndrome?

Headache, backache, breast discomfort, bloating, abdominal pain, irritability, depression

what is mastitis?

Breast inflammation most common in lactating women; Ascending infection from nipple to ducts—Breast becomes hard, inflamed, tender

how is mastitis treated?

Treatment is heat or cold application, mild analgesics, antibiotics, supportive brassiere (may need aspiration)

what is Fibroadenoma?

Firm round mass that is easily movable

• Asymptomatic and non-cancerous that can be excised

what are Fibrocystic changes?

Nodular breast masses that are more painful during menstrual cycle

• The most common form is non-proliferative

what is breast cancer?

Most common female cancer after skin cancer; Cancer develops when cells mutate and are not repaired

what are risk factors of breast cancer?

Sex, age, personal or family history, history of benign breast disease, hormonal influences

Mutation of BRCA1 or BRCA2 increases the risk

how can you reduce the risk of breast cancer for someone who is high risk?

Prophylactic mastectomy, aromatase inhibitors

how is breast cancer detected?

• Mass, puckering, nipple retraction, discharge

• Mammography

• Clinical breast examination

how is breast cancer treated?

Surgery, chemotherapy, radiation, hormonal therapy