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Congenital anomalies (absence of organs, improperly formed or abnormal organs) surgical treatment may help in some situations but cannot replace absent structures.
Irregular/absent ovulation (ovum released irregularly or not at all) ; endocrine therapy with clomiphene citrate (clomid)/ menotropins (pergonal) may induce ovulation; risk of ovarian hyperstimulation and release of multiple ova.
Tubal factors (fallopian tubes blocked or scarred from infection, surgery, endometrial neoplasm): treatment may include antibiotic therapy, surgery, hysterosalpingogram.
Uterine conditions (endometrium unreceptive, infected): removal of IUD, antibiotic therapy ,or surgery may be helpful.
Vaginal/cervical factors (hostile mucus, sperm allergies, altered pH due to infection): treatment with antibiotics, proper vaginal hygiene, or artificial insemination may be utilized.
In fertility of male partner, causes and therapy
Impotence: may be helped by psychologic counseling? Penile implants, medications.
Low abnormal sperm count (fewer than 20 million/ml semen. Low motility, more then 40% abnormal forms):
Varicocele (varicosity within spermatic cord): ligation may be successful.
-the cause is not known. Many women are anxious about their risk for breast cancer, and many tend to overestimate their risk. Even though genetic, hormonal, or biochemical factors are likely to be involved, 70% of women with breast cancer have no known risk factors.
personal history of breast cancer
family history of breast cancer
first child after 30 years of age
hormone therapy (HT)
exposure to ionizing radiation during adolescence and early adulthood
A contender lump appears in the breast, most frequently in the upper quadrant; it may be movable and isolated.
Pain usually is absent except in the late stages. A recent pain study indicated that 13% of patients described pain as a primary symptom; 7% indicated that it was the first clue that led to probe and examine the breast. Pain was described as “hurt” or “funny feeling” rather than acute or sharp.
Retraction or dimpling of the skin over the mass may be noted.
On mirror examination, asymmetry may be observed-the affected breast appears more elevated than the other.
Nipple retraction or nipple bleeding may be apparent.
Later, the nodule becomes more fixed to the chest wall.
when skin graft is anticipated, shave and clean donor area (usually anterior aspect of thigh.
if radical surgery is anticipated, have blood replacement available.
Upon the patient’s return from the recovery room, promote comfort and rest; administer analgesics for pain.
Encourage fluid and nutritional support as tolerated and desired.
Position the patient comfortably in semi-fowler’s position; if arm is free, elevate on a pillow; the most distal part (hand) is placed higher to permit gravity to aid in removal of fluid via lymphatics and venous pathways.
Check dressings for undue constriction, signs of hemorrhage, etc.; ensure that portable suction or other drainage devices are operating properly.
- occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina.
exact cause of cervical cancer is unknown
Human Papillovirus (HPV) is the leading cause of cervical cancer
Early cancer of the cervix is usually asymptomatic; it is almost always curable in its preinvasive stage.
Viral and chronic infections, as well as erosions of the cervix, appear to be significant in the development of cancer.
Incidence of cancer of the cervix is higher in groups with low socioeconomic status; occurs more often in black women than in white.
Risk Factors: - having multiple sexual partners or a partner who has had multiple sexual partner -early age of first intercourse -smoking tobacco -low socioeconomic status -STD’s -having sexual partner with a history of penile or prostate cancer It is most common between the ages of 35 and 55, but it can occur at any age
- most cervical cancers are of the squamous cell type. Squamous cell carcinoma ussually begins at the squamocolumnar junction, near the external end of the cervix. The spread of squamous cell cervical cancer occurs first by the direct extension to the vaginal mucosa the lower uterine segment, parametrium, pelvic wall, bladder and bowel. Distant metastasis occurs mainly through lymphatic spread, with some spread occuring through the circulatory system to the liver, lungs, or bones.
- no early indications of carcinoma in situ or early cervical cancer
-abnormal pap smear result
- presence of vaginal discharge
-bleeding especially after intercourse
-vaginal discharge which is normally watery, becomes dark and foul smelling
- caused by the gram-negative diplococcus, Neisseria gonorrhea, (non-motile, gram negative diplococcus;0.6-1.0 u in diameter
spread through contact with the penis, vagina, mouth, or anus
gonococci infect mucus-secreting epithelial surfaces. They attach to the columnar or transitional epithelium and penetrate through or between the cells to the connective tissue. This causes inflammation and spread of the infection
The causative agent is highly conatagious but does not live long outside the body. Gonorrhea is always transmitted through sexual contact. The incubation period is 3-8 days
- caused by Treponema palidum (motile spirochete with 6-14 spirals and ends pointed with finely spiral terminal filaments
Acquired by sexual contact or may be congenital
T. Pallidum enters the body through intact mucous membranes or abraded skin, almost exclusively by direct sexual contact. After entry, the organisms multiply locally an disseminate systematically through the blood stream and lympatics
- causes severity and recurs; highly contagious and ranks just below gonorrhea in incidence.
Incubation takes 2 to 20 days from when the infection is transmitted
After a 12-24 hour period of hypersensitivity or local discomfort (burning or tingling), multiple vesicular lesions (small blisters) appear which may subsequently produce a rosette formation.
The HSV organism is present in the exudate of the lesion. Herpes can be transmitted while a lesion is present and for 10 days after a lesion has healed. Genital herpes is transmitted by direct contact with the exudate during during sexual activity, but transmission is possible by fomites (object that can harbor pathogenic microorganisms
Most causative organism, chlamydia trachomatis is a non-motile gram negative bacteria.
This organism is the most common cause of what was previously diagnosed as non specific vaginititis in women and non-gonoccocal urethritis or NGU in men; transmitted by an intimate sexual contact the women usually acquire the infection during vaginal intercourse with an infected man and also oral, anal contact.
Can be transmitted to fetus at birth, causes neonatal ophthalmia.
Causes inflammation that leads to scarring and ulceration of involved tissue
In women the infection can extend to the endomitrium and salpinx (fallopian tube) the major consequence is salphingitis (inflammation of fallopian tube) with subsequent infertility or high risk of ectopic pregnancy and secondarily extension to the peritoneum can cause pelvic inflammatory disease or PID, if untreated
In men the infection can cause urethral stricture that may extend to the epididymis, sterility can result from ensuing the epididymis. A serious systemic complication more common in men is reiter’s syndrome which consist of urithritis, polyarthritis, conjunctivitis,
In women endocervix becomes edematous and produce a yellow mucupurulent vaginal discharge accompanied by spotting at menstrual mids cycle or with sexual intercourse, causes urethritis with dysuria and frequency of urination
In males uretrritis with dysuria and clear to mucopurulent discharge
In both sexes: proctitis (rectal inflammation) and pharyngitis.
Instruct clients about the greater risk of infection with multiple sexual partners and inform them of the serious danger of sterility, particularly for women .Stress that this infection may have long patency period.
Infected client should scrupulously avoid all sexual activity until both partners are cured and they should use condoms thereafter
Give doxycycline (vibramycin), zithromax and antibiotics.
Caused by other bacteria invading the vagina; most common cause of vaginal discharge in women
Link to sexual activity particularly having multiple sex partners; IT is often seen in women who douche, and it can occur after genital infection and invasive gynecological procedure
Infection is caused by the over growth of number of different organism including Gardenerela vaginalis and anaerobes overgrowth may occur when the normal flora and ph of the vagina altered and replace with high numbers of anaerobic bacteria.
Mild or aymptomatic
Mild ot moderate, mal odorous of vaginal discharge; a thin watery and grayish white intends to adhere the vaginal wall with the fishy smelling discharge
Mild vaginal burning and irritation
Presence of clue cells or either a saline wet mount or gram stain of vaginal fluid
Administer flagyl (metronidazole); treatment is recommended only when recurrent and resistant infection occur.