Genital Disease and STI

SAIT School of Health and Public Safety EMRG 251 Genital Disease and STI

Management of Gynecologic Trauma

• Female genital area is highly vascular:

  • Risk of profuse bleeding.

  • If bleeding is external, apply pressure.

  • If internal, treat similarly to any hypovolemic shock.

    (two large bore IVs)

  • Exsanguinating vaginal hemorrhage treated as any exsanguinating hemorrhage.

    exsanguinating hemorrhage is a deadly and critical bleed coming from the circulatory system of a vertebrae

Common Mistakes in Assessment

• Common Mistake: Not taking vaginal bleeding seriously.

• Assessment: Based on mechanism of injury; monitor for hypovolemic shock.

• Management:

  • Estimate accurate blood loss (use menstrual pads, blue pads, yellow sheet).

  • Keep large clots for hospital assessment.

  • Start two large bore IVs; ensure proper patient positioning.

Vaginal Bleeding

• Frequency: Vaginal bleeding is a common reason for gynecological consultation.

• Terminology:

  • Hypermenorrhea: Excessive duration or flow.

  • Polymenorrhea: Menstrual cycles occurring more frequently than every 28 days.

  • Metrorrhagia: Irregular but frequent bleeding.

  • Dysmenorrhea: Painful menstruation

    • Primary Dysmenorrhea: Starts with menstrual flow, lasts 1 to 2 days.

    • Secondary Dysmenorrhea: Occurs before, during, and after menstruation.

Life-threatening Gynecologic Emergencies

• Include:

  • Ectopic pregnancy

  • Ruptured ovarian cyst

  • Tubo-ovarian abscess

  • Ovarian torsion

Ectopic Pregnancy

• Pathophysiology:

  • Fertilized oocyte implants outside the uterus, commonly in a fallopian tube (97% of cases).

  • Growth leads to tube rupture, causing life-threatening bleeding.

Ectopic Pregnancy Assessment

• Chief Complaint: Abdominal pain, typically localized and crampy, with vaginal bleeding after pain onset.

Ovarian Cysts, Ovarian Torsion, and Tubo-Ovarian Abscess Pathophysiology

• Excessive cycle of cyst formation may lead to polycystic ovaries, affecting hormone production and insulin regulation.

Ovarian Cysts

• Types:

  • Functional cysts: most common, Develop during menstrual cycle.

    • Follicular cyst: Fails to rupture once egg matures

    • Corpus luteum cyst: Seals post-oocyte release, accumulates fluid.

  • Dermoid cyst: Contains formation tissue (teeth/hair).

  • Cystadenomas: Mucous-filled, can be large and painful.

  • Hemorrhagic cyst: Bursting blood vessels cause pain and bleeding into the cavity.

Assessment of Ovarian Cysts

• A patient with an ovarian cyst my report:

  • Dull, achy lower back and thigh pain

  • Abdominal pain/pressure, nausea/vomiting

  • Abnormal bleeding and painful menstruation

• A patient with a ruptured ovarian cyst

  • Sharp lower abdominal pain

  • distention

  • dizziness, weakness, syncope.

Ovarian Torsion Assessment

• cysts not self-resolving and continuously grows significantly (around 10 cm).

• Symptoms:

  • Sudden severe lower abdominal pain on the affected side

  • Nausea, vomiting

  • tachycardia and tachypnea.

Tubo-Ovarian Abscess Assessment

• Blockage of fallopian tubes/ovaries by infectious mass.

• Symptoms:

  • Severe abdominal pain, guarding, rebound tenderness

  • Nausea, vomiting

  • abdominal distention

  • fever.

Management of Gynecologic Emergencies

• in the pre-hospital setting, ectopic pregnancies, ovarian torsion, ruptured ovaria cyst, and tubo-ovarian abscess present the same and can be difficult to differentiate.

• Approach:

  • Start two large bore IVs for pain management and shock treatment.

  • Administer antiemetics as needed.

Prolapsed Uterus

• Pathophysiology: Uterus drops from normal position due to weakened pelvic floor muscles, tissues, and ligaments;

  • common with multiple vaginal childbirths and menopause.

• Types of Pelvic Organ Prolapse:

  • Cystocele: Bladder protruding into the vagina.

  • Rectocele: Rectum protruding into the vagina.

Prolapsed Uterus Assessment

• Symptoms:

  • Vaginal/pelvic pain or low back pain

  • Pelvic pressure

  • dysuria, incontinence, abnormal discharge.

• assess for any signs of shock

Prolapsed Uterus Management

• Limited prehospital treatment:

  • IV pain management, treatment for shock.

  • DO NOT RE-PLACE ANY TISSUE; cover with moist sterile dressing (like abdominal evisceration).

Endometriosis vs Endometritis

• Endometriosis : Uterine lining grows outside uterus, particularly on ovaries, fallopian tubes, causing severe pain and infertility.

  • tissue has no way to exit the body during menstruation

• Endometritis: Inflammation of the endometrium (inside)

  • common post childbirth or due to infections.

Endometriosis Assessment

• Symptoms:

  • Deep pelvic/lower back pain (since it’s outside the uterus but around the tubes and ovaries) worsening with menstruation

  • Heavy menstruation (menorrhagia), fatigue, painful intercourse, or bowel movements.

Endometritis Assessment

• Symptoms:

  • Uterine pain, abnormal vaginal bleeding/discharge

  • Fever, generalized discomfort.

Toxic Shock Syndrome (TSS)

• Rare life-threatening illness, happens suddenly after an infection (Staphylococcus aureus, Group A Streptococcus).

• TSS from strep often occurs post-childbirth

• while staph related to prolonged tampon use or surgeries.

Toxic Shock Syndrome Assessment

• Symptoms:

  • Fever, flu-like symptoms, headache, (ALOC)

  • hypotension

  • Myalgia, diarrhea/vomiting,

  • deep red rash (like sunburn), particularly on palms and soles.

Management of Toxic Shock Syndrome

• Approach:

  • Supportive care

  • IV fluids

  • fever management (tylenol)

  • oxygen therapy.

Mastitis

• Inflammation of the breast due to infection or blocked milk duct; common in breastfeeding women.

• Cracked or sore nipples allow bacteria entry; may involve pus discharge and abscess formation.

Mastitis Assessment

• Symptoms:

  • Cracked sore nipples

  • redness, swelling/lumps, discharge

  • fever, flu-like symptoms.

  • swelling

  • SEPSIS

Mastitis Management

• Continue breastfeeding; drain milk completely.

  • Warm moist compresses, massage from infected area to nipple

  • antipyretic/analgesic medication

  • IV

Testicular Torsion

• Pathophysiology: rotation of the testicles, Twisting of spermatic cord leading to acute pain and swelling

  common in:

  • adolescents

  • trauma (sports injury)

  • sleeping

  • bell clapper deformity

Testicular Torsion Assessment

• Symptoms include:

  • swelling/pain

  • nausea/vomiting/dizziness

  • lumps in scrotal sac

  • blood in semen

Testicular Torsion Management

• Treatment involves surgery.

  • Potential for manual detorsion in the emergency department.

  • Surgical detorsion or testicle removal if necrosis occurs.

Benign Prostatic Hyperplasia (BPH)

• Pathophysiology of BPH: Enlargement of the prostate around the urethra, non-cancerous, does not metastasize.

Assessment of BPH

• Symptoms:

  • Dysuria, hematuria, pelvic pain, urinary incontinence.

Management of BPH

• Supportive care,

• analgesia as needed.

Pelvic Inflammatory Disease (PID)

• Infection of female upper reproductive organs, often result of untreated STIs like gonorrhea or chlamydia.

  • Can lead to abscess formation, increased risk of ectopic pregnancy, infertility, and chronic pain.

  • infection of fallopian tubes and uterus occur together

  • pus may collect in fallopian tubes and abcess may form

• increased risk of ectopic pregnancy and infertility

PID Assessment

• Symptoms:

  • Diffuse lower abdominal pain, rebound tenderness, guarding

  • Yellowish vaginal discharge, fever, pain with

  • intercourse/urination.

  • PID and appendicitis can be difficult to distinguish, ask gyne questions to differentiate between the two conditions, such as menstrual history, sexual activity, and any recent pelvic infections.

PID Management

• Supportive care, analgesia, antipyretics, antibiotics.

  • Ensure treatment of sexual partners with antibiotics and promote condom use.

STI Management

• Oral antibiotics for bacterial STIs (gonorrhea, chlamydia).

• Supportive care for viral STIs (genital warts, herpes, HIV): manage symptoms without curing underlying infection.