Female Reproductive Disorders - Comprehensive Study Guide

Key Terms

• Menarche: The first occurrence of menstruation, typically occurring between ages $10$ and $16$.

• Dysmenorrhea: Painful menstruation, often involving abdominal cramps.

• Dyspareunia: Difficult or painful sexual intercourse.

• Adnexa: The appendages of the uterus, namely the ovaries and fallopian tubes.

• Amenorrhea: The absence of menstruation; primary (never started by age $16$) or secondary (stopped for $3$ to $6$ months).

• Metrorrhagia: Bleeding between regular menstrual periods.

• Menorrhagia: Excessive menstrual bleeding in duration or amount (>80\text{ mL} per cycle).

• Infertility: The inability to conceive after $12$ months of regular unprotected sexual intercourse ($6$ months for women over $35$).

Anatomy and Physiology: Hormonal Regulation

• Hypothalamic-Pituitary-Ovarian Axis:

  • Gonadotropin-Releasing Hormone (GnRH): Released by the hypothalamus to stimulate the anterior pituitary.

  • Follicle-Stimulating Hormone (FSH): Stimulates the growth of ovarian follicles and the secretion of estrogen.

  • Luteal Hormone (LH): Triggers ovulation and the development of the corpus luteum.

• Ovarian Hormones:

  • Estrogen: Responsible for secondary sex characteristics and thickening the endometrial lining.

  • Progesterone: Produced by the corpus luteum; maintains the endometrial lining for implantation and pregnancy.

Health History and Assessment

• Obstetric History (GTPAL System):

  • G (Gravida): Total number of pregnancies.

  • T (Term): Number of pregnancies delivered at $37$ weeks or later.

  • P (Preterm): Number of pregnancies delivered between $20$ and $36$ weeks.

  • A (Abortion): Number of pregnancies ending before $20$ weeks (spontaneous or induced).

  • L (Living): Number of currently living children.

• Menstrual History: Assess the interval between periods (normal is $21-35$ days) and the number of pads/tampons used per day to quantify blood loss.

Diagnostic Tests and Detailed Procedures

• Papanicolaou (Pap) Smear: Screening for cervical cancer by scraping cells from the squamocolumnar junction.

  • Instruction: Advise the patient not to douche, use vaginal medications, or have intercourse for $24-48$ hours prior.

• Hysterosalpingography: An X-ray with contrast to visualize the uterus and fallopian tubes to check for patency.

  • Nursing Alert: Assess for iodine or shellfish allergies before the procedure.

• Mammography: Detection of microcalcifications.

  • Guidelines: Annual screenings starting at $40-45$ years old. Patients must avoid deodorant or powder, as these can appear as calcium deposits on the film.

• Dilation and Curettage (D&C):

  • Used for diagnosis (endometrial tissue sampling) or treatment (managing incomplete miscarriage or polyps).

  • Post-op Care: Monitor for hemorrhage (check perineal pads) and vasovagal syncope.

Specific Reproductive Disorders

1. Infections and Inflammatory Conditions

• Candidiasis (Yeast Infection): Characterized by a thick, white, "cottage cheese" discharge and intense pruritus. Treated with antifungal creams or oral fluconazole.

• Trichomoniasis: A protozoan infection causing a malodorous, frothy, thin, yellow-green discharge and "strawberry cervix" (petechiae). Both partners must be treated with metronidazole.

• Bacterial Vaginosis (BV): Overgrowth of anaerobic bacteria; presents with a fishy odor and thin grey-white discharge. Diagnosed via "clue cells" on a wet mount.

• Pelvic Inflammatory Disease (PID):

  • Pathophysiology: Infection of the upper reproductive tract (uterus, tubes) usually caused by untreated Chlamydia or Gonorrhea.

  • Complications: Scars the fallopian tubes, leading to a high risk of ectopic pregnancy and chronic pelvic pain.

2. Endometriosis

• Description: Functioning endometrial tissue grows outside the uterine cavity, responding to hormonal cycles by bleeding into the pelvic cavity.

• Clinical Manifestations: Cyclical pelvic pain, infertility, and "chocolate cysts" (endometriomas) on the ovaries.

• Management: NSAIDs for pain, oral contraceptives to suppress ovulation, or Lupron to induce a "pseudo-menopause" state.

3. Breast Cancer and Surgical Management

• Types: Ductual Carcinoma in Situ (DCIS) or Infiltrating Ductal Carcinoma (most common).

• Risk Factors: Early menarche (<12), late menopause (>55), nulliparity (no children), and BRCA$1$/BRCA$2$ gene mutations.

• Nursing Care Post-Mastectomy:

  • Lymphedema Prevention: No BP, blood draws, or injections in the affected arm.

  • Elevation: Elevate the affected arm on pillows to promote lymphatic drainage.

  • Exercise: Encourage hand-squeezing and progressive arm exercises (e.g., "wall crawling").

4. Structural Abnormalities

• Cystocele: Protrusion of the bladder into the vagina, often causing stress incontinence.

• Rectocele: Protrusion of the rectum into the vagina, often causing constipation or a feeling of rectal pressure.

• Intervention: Kegel exercises to strengthen pelvic floor muscles or surgical repair (Anterior/Posterior Colporrhaphy).

Advanced Nursing Considerations

• Psychosocial Support: Issues involving the reproductive system often impact self-image, sexuality, and fertility. Provide a non-judgmental environment.

• Hysterectomy Post-Op: Monitor for urinary retention (common after pelvic surgery) and assess for signs of Deep Vein Thrombosis (DVT) due to the lithotomy position used during surgery.

• Education: Teach patients that douching is generally discouraged as it alters the pH and washes away protective lactobacilli, increasing infection risk.