Elizabeth Gonzalez Dr. Alain Llanes Rojas Advanced Primary Family   Reproductive Health across the lifespan 1 Labor and Birth Processes A woman and the fetus during the late pregnancy prepares for labor process. During this period the fetus is ready for extra uterine life. There are several physiologic adaptations that a woman undergoes which prepares her for birth and motherhood. The end of pregnancy is represented by the labor and birth process which ushers in a extra uterine life for the newborn and a change for the family. . 2 Birth Process Giving Birth In United States Model of birth Medical model Midwifery Site of birth Home Birth center Hospital Stages of Labor First stage: latent, active, transition Dilatation Second stage Pushing and birth Third stage Delivery of placenta First Stage DILATATION The first stage of labor is divided into three phases: latent, active, and transition. The first, the latent phase, is the longest and least intense. During this phase, contractions become more frequent, helping your cervix to dilate so your baby can pass through the birth canal Active phase You may feel intense pain or pressure in your back or abdomen during each contraction. Transition phase During transition, the cervix fully dilates to 10 centimeters. Contractions are very strong, painful, and frequent, coming every three to four minutes and lasting from 60 to 90 seconds. Second stage: PUSHING AND BIRTH Begins when the cervix is completely opened. At this point, your doctor will give you the OK to push. Your pushing, along with the force of your contractions, will propel your baby through the birth canal. The fontanels (soft spots) on your baby's head allow it to fit through the narrow canal. Your baby's head crowns when the widest part of it reaches the vaginal opening. As soon as your baby's head comes out, your doctor will suction amniotic fluid, blood, and mucus from his or her nose and mouth Third stage: DELIVERY OF THE PLACENTA After your baby is delivered, you enter the final stage of labor. In this stage, you deliver the placenta, the organ that nourished your baby inside the womb. Each woman and each labor is different. The amount of time spent in each stage of delivery will vary. If this is your first pregnancy, labor and delivery usually lasts about 12 to 14 hours. The process is usually shorter for subsequent pregnancies. Stages of Labor Labor Process True Vs False Labor True labor Discomfort in the abdomen and the back The cervix dilates Sedation cannot stop the discomfort Contractions at regular intervals Gradually intensity increase False labor Intensity always remains to be the same No cervical dilatation Sedation can relieve discomfort Contractions at irregular intervals Pain Management In Active Labor Hydrotherapy Backrubs Analgesia Birth ball Waling/movement Medications Several drugs are used to help ease the pain of la.

1. Elizabeth Gonzalez
Dr. Alain Llanes Rojas
Advanced Primary Family
Reproductive Health across
the lifespan
1
Labor and Birth Processes
A woman and the fetus during the late pregnancy prepares for
labor process. During this period the fetus is ready for extra
uterine life. There are several physiologic adaptations that a
woman undergoes which prepares her for birth and motherhood.
The end of pregnancy is represented by the labor and birth
process which ushers in a extra uterine life for the newborn and
a change for the family.
.

2. 2
Birth Process
Giving Birth In United States
Model of birth
Medical model
Midwifery
Site of birth
Home
Birth center
Hospital
Stages of Labor
First stage: latent, active, transition
Dilatation
Second stage
Pushing and birth
Third stage
Delivery of placenta
First Stage DILATATION
The first stage of labor is divided into three phases: latent,

3. active, and transition.
The first, the latent phase, is the longest and least intense.
During this phase, contractions become more frequent, helping
your cervix to dilate so your baby can pass through the birth
canal
Active phase
You may feel intense pain or pressure in your back or abdomen
during each contraction.
Transition phase
During transition, the cervix fully dilates to 10 centimeters.
Contractions are very strong, painful, and frequent, coming
every three to four minutes and lasting from 60 to 90 seconds.
Second stage: PUSHING AND BIRTH
Begins when the cervix is completely opened. At this point,
your doctor will give you the OK to push. Your pushing, along
with the force of your contractions, will propel your baby
through the birth canal. The fontanels (soft spots) on your
baby's head allow it to fit through the narrow canal.
Your baby's head crowns when the widest part of it reaches the
vaginal opening. As soon as your baby's head comes out, your
doctor will suction amniotic fluid, blood, and mucus from his or
her nose and mouth

4. Third stage: DELIVERY OF THE PLACENTA
After your baby is delivered, you enter the final stage of labor.
In this stage, you deliver the placenta, the organ that nourished
your baby inside the womb.
Each woman and each labor is different. The amount of time
spent in each stage of delivery will vary. If this is your first
pregnancy, labor and delivery usually lasts about 12 to 14
hours. The process is usually shorter for subsequent
pregnancies.
Stages of Labor
Labor Process
True Vs False Labor
True labor
Discomfort in the abdomen and the back
The cervix dilates
Sedation cannot stop the discomfort
Contractions at regular intervals
Gradually intensity increase
False labor

5. Intensity always remains to be the same
No cervical dilatation
Sedation can relieve discomfort
Contractions at irregular intervals
Pain Management In Active Labor
Hydrotherapy
Backrubs
Analgesia
Birth ball
Waling/movement
Medications
Several drugs are used to help ease the pain of labor and
delivery. Although these drugs are generally safe for the mother
and baby, as with any drugs, they have the potential for side
effects.
An epidural block continuously administers pain medication to
the area around your spinal cord and spinal nerves through a
catheter inserted into the epidural space
Anesthetics block all feeling, including pain. They also block
muscle movement. General anesthetics cause you to lose
consciousness. If you have a cesarean delivery, you may be
given general, spinal, or epidural anesthesia.

6. Non Drug Options
Non-drug methods for relieving pain include acupuncture,
hypnosis, relaxation techniques, and changing position
frequently during labor.
Even if you choose non-drug pain relief, you can still ask for
pain medications at any point during your delivery
Fetal Assessment
Fetal Assessment During Labor
What to asses
Fetal heart rate (FHR): the primary assessment.
The amniotic fluid
Fetal Heart Monitoring
Methods of fetal heart monitoring
Intermittent auscultation
Electronic fetal monitoring
Internal
External

7. FHR Patterns
Normal patterns
Baseline FHR=120-160bpm(beat/min.)
Tachycardia
Baseline FHR above 160bpm
Bradycardia
Baseline FHR less than 120 bpm
*Baseline FHR=10 minutes*
Contradiction Pattern
Normal contradiction
This happens in 5 or less contradictions in 10 minutes which
last for in 60 seconds in the active phase
Contradiction intensity
Happens in the second stage 30 mmHg in early labor to 70-90
mmHg
Periodic changes
These are accelerations or decelerations which happens in the
FHR that are in relation to uterine contractions and do persist
over time.
Management

8. Early deceleration: An early deceleration represents an
autonomic response to changes in intracranial pressure or
cerebral blood flow caused by intrapartum compression of the
fetal head during a uterine contraction and maternal expulsive
efforts.
Variable deceleration: Reflects the fetal autonomic reflex
response to transient mechanical compression of the umbilical
cord
Late deceleration : Is a reflex fetal response to transient
hypoxemia during a uterine contraction.
Situations Where The Fetal Heart Rate Pattern Is Abnormal
This means the fetus is not getting enough oxygen
The cause should be found
Steps taken to ensure the baby get enough oxygen
Id the procedure is not successful and the fetus has problems the
baby should be delivered immediately
The child will most likely be delivered through cesarean or
vacuum delivery or forceps
Reference
Buckley, S. J. (2015). Executive summary of hormonal
physiology of childbearing: evidence and implications for
women, babies, and maternity care. The Journal of perinatal
education, 24(3), 145.
King, T. L., Brucker, M. C., Fahey, J., Kriebs, J. M., & Gegor,
C. L. (Eds.). (2015). Varney's midwifery (p. 3). Burlington,

9. MA: Jones & Bartlett Learning.
Simpson, K. R. (2016). Research about nurse staffing during
labor and birth is greatly needed and long overdue. Nursing for
women's health, 20(4), 343-345.
https://www.webmd.com/baby/guide/normal-labor-and-delivery-
process#3
Screening for Breast Cancer, Cervical Cancer, Ovarian Cancer,
and Endometrial Cancer
FNU
Karel Bell-Lloch
1
Definition
Cancer occurs as a result of mutations, or abnormal changes, in
the genes responsible for regulating the growth of cells and
keeping them healthy.
That changed cell gains the ability to keep dividing without
control or order, producing more cells just like it and forming a
tumor.
2

10. Cancer in the female population
Breast cancer:
Cervical Cancer
Ovarian cancer
Endometrial cancer
Breast cancer
The term “breast cancer” refers to a malignant tumor that has
developed from cells in the breast.
Breast cancer
A. Ducts
B. Lobules
D. Nipple
Breast Cancer epidemiology
About 1 in 8 U.S. women (about 12.4%) will develop invasive
breast cancer over the course of her lifetime.
In 2018, an estimated 266,120 new cases of invasive breast
cancer are expected to be diagnosed in women in the U.S., along
with 63,960 new cases of non-invasive (in situ) breast cancer.
In women under 45, breast cancer is more common in African-
American women than white women
About 85% of breast cancers occur in women who have no
family history of breast cancer. These occur due to genetic
mutations that happen as a result of the aging process and life in
general, rather than inherited mutations.

11. These occur due to genetic mutations that happen as a result of
the aging process and life in general, rather than inherited
mutations.
6
Breast cancer risk factors
The most significant risk factor for breast cancer are gender
(being a woman) and age (growing older).
Alcohol intake, smoking and obesity
A man’s lifetime risk of breast cancer is about 1 in 1,000.
7
Guidelines for breast cancer screening
Women ages 40 to 44 should have the choice to start annual
breast cancer screening with mammograms
Women age 45 to 54 should get mammograms every year.
Women 55 and older should switch to mammograms every 2
years, or can continue yearly screening.
Screening should continue as long as a woman is in good health
and is expected to live 10 more years or longer
Mammogram

12. During a mammogram, your breasts are compressed between
two firm surfaces to spread out the breast tissue. Then an X-ray
captures black-and-white images of your breasts that are
displayed on a computer screen and examined by a doctor who
looks for signs of cancer.
Patient education.
Eating a balanced diet, maintaining a healthy weight, not
smoking, limiting alcohol, and exercising regularly
9
Cervical cancer
Definition:
Cervical cancer is
a type of cancer that
occurs in the cells of
the cervix — the lower
part of the uterus that
connects to the vagina.
Squamous cell carcinoma. Outer part of the cervix. Most
cervical cancers are squamous cell carcinomas.
Adenocarcinoma. This type of cervical cancer begins in the
column-shaped glandular cells that line the cervical canal.
10
Cervical cancer risk factors

13. Many sexual partners.
Early sexual activity.
Other sexually transmitted infections (STIs).
A weak immune system.
Smoking. Smoking is associated with squamous cell cervical
cancer.
Smoking. Smoking is associated with squamous cell cervical
cancer.
11
Cervical Cancer Epidemiology
12,578 new cases were diagnosed in 2014 (rate = 7.5 per
100,000 women).1
4,115 deaths in 2014 (rate = 2.3 per 100,000 women).1
Decline in cases and deaths in past 40 years correlated with Pap
testing and detection and treatment of cervical pre-cancerous
lesions.
Treatment costs top $2 billion per year.
The majority of cancers (50% to 64%) occur in women who
were rarely or never screened.
Guide lines for cervical cancer screening according to CDC.
Cervical cancer testing should start at age 21.
Women between the ages of 21 and 29 should have a Pap test
done every 3 years.
Women between the ages of 30 and 65 should have a Pap test
plus an HPV test (“co-testing”) done every 5 years. This is the

14. preferred approach, but it’s OK to have a Pap test alone every 3
years.
Women over age 65 who have had regular cervical cancer
testing in the past 10 years with normal results should not be
tested .
Women with a history of a serious cervical pre-cancer should
continue to be tested for at least 20 years after that diagnosis,
even if testing goes past age 65.
A woman who has had her uterus and cervix removed (a total
hysterectomy) for reasons not related to cervical cancer should
not be tested.
All women who have been vaccinated against HPV should still
follow the screening recommendations for their age groups.
Women between the ages of 21 and 29 should have a Pap test
done every 3 years. HPV testing should not be used in this age
group unless it’s needed after an abnormal Pap test result.
13
Cervical cancer screening test
Pap smear and HPV
Testing
-Atypical squamous cells
(ASC)
-Low-grade squamous
intraepithelial lesions
(LSILs)
High-grade squamous
intraepithelial lesions
(HSILs)
-Squamous cell carcinoma

15. Atypical squamous cells (ASC) are the most common abnormal
finding in Pap tests.
Squamous cell carcinoma is cervical cancer. The abnormal
squamous cells have invaded more deeply into the cervix or into
other tissues or organs.
14
Cervical cancer patient education
Get vaccinated against HPV. Vaccination is available for girls
and women ages 9 to 26.
Have routine Pap tests. Pap tests can detect precancerous
conditions of the cervix, so they can be monitored or treated in
order to prevent cervical cancer.
Most medical organizations suggest women begin routine Pap
tests at age 21 and repeat them every few years.
Practice safe sex. Using a condom, having fewer sexual partners
and delaying intercourse may reduce your risk of cervical
cancer.
Don't smoke.
To reduce your risk of cervical cancer:
The vaccine is most effective if given to girls before they
become sexually active.
15
Ovarian cancer
Ovarian cancer is a type of cancer that begins in the ovaries.
Ovarian cancer often goes undetected until it has spread within
the pelvis and abdomen. At this late stage, ovarian cancer is
more difficult to treat and is frequently fatal.

16. Epithelial tumors, which begin in the thin layer of tissue that
covers the outside of the ovaries.
Stromal tumors, which begin in the ovarian tissue that contains
hormone-producing cells.
Germ cell tumors, which begin in the egg-producing cells.
16
Ovarian cancer risk factors
Older age.
Inherited gene mutations.
Family history of ovarian cancer.
Estrogen hormone replacement therapy, especially with long-
term use and in large doses.
Age when menstruation started and ended. Beginning
menstruation at an early age or starting menopause at a later
age, or both, may increase the risk of ovarian cancer.
Older age. Ovarian cancer can occur at any age but is most
common in women ages 50 to 60 years.
Inherited gene mutations. A small percentage of ovarian cancers
are caused by gene mutations you inherit from your parents.
Family history of ovarian cancer. People with two or more close
relatives with ovarian cancer have an increased risk of the
disease.
Estrogen hormone replacement therapy, especially with long-
term use and in large doses.
Age when menstruation started and ended. Beginning
menstruation at an early age or starting menopause at a later
age, or both, may increase the risk of ovarian cancer.
17

17. Ovarian Cancer Epidemiology
Ovarian cancer is the second most common gynecologic cancer.
21,161 new cases were diagnosed in 2014 (rate = 11.0 per
100,000 women).1
14,195 deaths in 2014 (rate = 7.0 per 100,000 women).1
The five-year survival rate for women diagnosed between 2007
and 2013 is 46.7%.
Ovarian cancer is the second most common gynecologic
cancer.1 It causes more deaths than any other gynecologic
cancer, but it accounts for only about 3% of all cancers in
women. The highest incidence is among white women.
21,161 new cases were diagnosed in 2014 (rate = 11.0 per
100,000 women).1
14,195 deaths in 2014 (rate = 7.0 per 100,000 women).1
The five-year survivial rate for women diagnosed between 2007
and 2013 is 46.7%.
18
Ovarian cancer guide lines screening
There is no simple and reliable way to screen for ovarian cancer
in women who do not have any signs or symptoms.
You should have a diagnostic test, like a rectovaginal pelvic
exam, a transvaginal ultrasound, or a CA-125 blood test if you
have any unexplained signs or symptoms of ovarian cancer.
Ovarian cancer signs and symptoms
Vaginal bleeding (particularly if you are past menopause), or
discharge from your vagina that is not normal for you.
Pain or pressure in the pelvic area.
Abdominal or back pain.

18. Bloating.
Feeling full too quickly, or difficulty eating.
A change in your bathroom habits, such as more frequent or
urgent need to urinate and/or constipation.
Patient education. To see a doctor if she has symptoms
20
Endometrial cancer definition
Definition:
Endometrial cancer is a type of cancer that begins in the uterus.
It begins in the layer of cells that form the lining (endometrium)
of the uterus.
The accumulating abnormal cells form a mass (tumor). Cancer
cells invade nearby tissues and can separate from an initial
tumor to spread elsewhere in the body (metastasize).
Endometrial cancer is sometimes called uterine cancer.
Endometrial cancer is often detected at an early stage because it
frequently produces abnormal vaginal bleeding, which prompts
women to see their doctors. If endometrial cancer is discovered
early, removing the uterus surgically often cures endometrial
cancer.
21
Endometrial cancer
Endometrial cancer screening test

19. There is no standard or routine screening test for endometrial
cancer but
Pap test results sometimes show signs of an abnormal
endometrium.
Transvaginal ultrasound (TVU) is an also useful procedure to
examine the vagina, uterus, fallopian tubes, and bladder.
Endometrial cancer
Transvaginal ultrasound (TVU) is commonly used to examine
women who have abnormal vaginal bleeding.
Ultrasound wand into the vagina. It can help find a mass
(tumor) in the ovary, but it can't actually tell if a mass is cancer
or benign.
24
Endometrial cancer risk factors
Changes in the balance of female hormones in the body. Your
ovaries make two main female hormones — estrogen and
progesterone.
More years of menstruation. Starting menstruation at an early
age — before age 12 —
Never having been pregnant.
Older age
Obesity. Being obese. This may occur because excess body fat
alters your body's balance of hormones.
Endometrial cancer
At this particular type of cancer women needs to be aware of
signs and symptoms:

20. Vaginal bleeding after menopause.
Bleeding between periods.
An abnormal, watery or blood-tinged discharge from your
vagina.
Pelvic pain.
References
Types of Prevention. (2018). Retrieved from
https://cursos.campusvirtualsp.org/mod/tab/view.php?id=23157
What Is Breast Cancer? | Breastcancer.org. (2018). Retrieved
from
https://www.breastcancer.org/symptoms/understand_bc/what_is
_bc?gclid=CjwKCAjwrNjcBRA3EiwAIIOvq_L1ETaEZaOF2R5
RiWiUDFFjHFu5ZnWsfqBrQC_6u4ZfiEDfOGLDDBoCimAQAv
D_BwE
Cervical cancer - Symptoms and causes. (2018). Retrieved from
https://www.mayoclinic.org/diseases-conditions/cervical-
cancer/symptoms-causes/syc-20352501
Endometrial cancer - Symptoms and causes. (2018). Retrieved
from https://www.mayoclinic.org/diseases-
conditions/endometrial-cancer/symptoms-causes/syc-20352461
CDC - Cervical Cancer Epidemiology in the U.S. - Gynecologic
Cancer Curriculum - Inside Knowledge Campaign. (2018).
Retrieved from
https://www.cdc.gov/cancer/knowledge/provider-
education/cervical/epidemiology.htm
References
CDC - Ovarian Cancer Epidemiology in the U.S. - Gynecologic
Cancer Curriculum - Inside Knowledge Campaign. (2018).
Retrieved from

21. https://www.cdc.gov/cancer/knowledge/provider-
education/ovarian/epidemiology.htm
Final Update Summary: Cervical Cancer: Screening - US
Preventive Services Task Force. (2018). Retrieved from
https://www.uspreventiveservicestaskforce.org/Page/Document/
UpdateSummaryFinal/cervical-cancer-screening
Pap and HPV Testing. (2018). Retrieved from
https://www.cancer.gov/types/cervical/pap-hpv-testing-fact-
sheet#q3
Can Ovarian Cancer Be Found Early? | Ovarian Cancer
Screening. (2018). Retrieved from
https://www.cancer.org/cancer/ovarian-cancer/detection-
diagnosis-staging/detection.html
Presentation :
Chronic Pelvic pain , Dysmenorrhea, Dyspareunia
Suzelle L. Costales
Advanced Primary care of family II
Florida National University
What is Chronic Pelvic Pain and what are s/s ?
Chronic pelvic pain is pain below the umbilicus mainly at and
around the pelvic area of the body , pain associated with CPP is
pain that lasts more than six months and is not associated with
menstrual period symptoms.
Incomplete relief with OTC treatments
Significantly impaired function at work or home/ sex life
Altered family roles
Signs of depression , weight loss /gain and anxiety.
Chronic pelvic pain can be associated with other disease process
and usually arises from gynecological causes

22. Chronic Pelvic Pain epidemiology / Pathophysiology
CPP is a common reason for office visit in the US. According
statistics 1 out of 7 women in the USA visit a medical office
with chief complaint of chronic pelvic pain.
Of all references to a gyn specialist 10 % are for pelvic pain and
prevalence for CPP in reproductive aged women is aprox 39 %.
CPP is considered a symptom of an underlying problem that can
be gynecological , gastrointestinal and neuro-muscular in
origin. CPP can be very complex to treat due to the many
factors that can be contributing and causing CPP. Each provider
takes a personalized approach for each patient in order to find
the root cause of CPP.
Risk Factors of Chronic Pelvic Pain
C- section
Endometriosis ( endometrial cells grow outside the uterus )
Miscarriage
Longer menstrual flow
Ovarian cysts
Uterine fibroids
Vaginismus
Pelvic inflammatory disease
Long term sexual abuse as child or adult
Adenomyosis ( endometrial tissue growing in uterine wall)
Hysterectomy
Chronic UTI
Bladder Stones

23. Guidelines for screening : CPP
Accurate and complete Health history: important to get
chronological history of pain.
Physical examination : gynecological, urologic ,
gastroenterological , and psychologic examination ,
musculoskeletal exam
Assess pain each visit / detailed
Vaginal examination , pap smear, pelvic examination: single
digit and bimanual
Labs: CBC, Urinalysis, pregnancy test , STD test,
Transvaginal ultrasound , CT scan , MRI, laparoscopy
Dysmenorrhea
“Menstrual cramps” or pain that is associated with the
menstrual cycle each month.
Lasts 3-5 days , starts before menstruation begins can last
during and after menstruation
Pain is mainly in the pelvis and lower abdomen
More than 50 % of women experience some level of
dysmenorrhea each month right before and or/ during their
menstrual cycle.
Dysmenorrhea
Dysmenorrhea occurs due to “ Prostaglandins “ ( hormone found
in uterus) the inflammatory trigger which leads to uterine
muscle contractions that help to released or expel the lining.
Prostaglandins are hormones in the body responsible for muscle
contraction and relaxation mainly of smooth muscle tissue in
the body.

24. Some women have higher levels of prostaglandin hormone in
the body leading to more severe pain , nausea , bloating and
discomfort during their menstruation.
Dysmenorrhea can begin as early as 2 – 3 years after menarche
and varies in severity from woman to woman
Risk factors for Dysmenorrhea
Heavy menstrual flow
Age < 20 years
Early menarche < 12 y rs
Overweight
Underweight
High stress
Anxiety
Family history
Smokking
Dysmenorrhea
Primary Dysmenorrhea
Usually pain is moderate although can be severe at times but not
for long periods , lasts 2-3 days at start of period
Responds well to OTC medication and home remedies
Not caused by underlying disease of the uterus or pelvis
Occurs before and during period
Secondary dysmenorrhea
Dysmenorrhea occurring during menstruation when underlying
disease is present such as endometriosis.
More prevalent in women in their late 30 s and 40 s
Pain becomes stronger or begins suddenly later in life. Patient
will have sudden new onset pain during menstruation.
Secondary dysmenorrhea should be investigated further

25. Secondary Dysmenorrhea Causes
Extrauterine causes : endometriosis , PID, Adhesions, structural
abnormalities of genital tract
Intramural ( in the muscle layer of Uterus) : adenomyosis ,
fibroid
Intrauterine : infection , polyps, cervical stenosis , intrauterine
contraception
Dysmenorrhea : Assessing and TX
When assessing a female for the first time its important to
always ask when was the last menstrual period , age of
menarche and any unusual bleeding, or changes in mood/
behavior. A though history and physical assessment should be
done : time and pattern? heaviness of menstruation? , what self
treatments have you tried? Other symptoms ?
Dysmenorrhea is usually managed in the home with OTC
remedies , without the need for a prescription
Can be managed with OTC pain relievers such as NSAIDS and
sometimes if severe hormonal options such as birth control or
IUD an be prescribed as well if pain is severe. Home remedies
such as Hot compresses , exercise, taking vitamins: Fish oil
omega 3 , magnesium, B1 B6 vitamin C, vitamin E,
Abdominal / transvaginal US , laparoscopy, blood test and
culture ( rule out std )
Dyspareunia
What is Dyspareunia ? S/S?

26. Painful intercourse in female or males , more frequently occur
in women
Pain can be moderate to severe and occurs during penetration.
Can be due to physiological and or psychological factors.
Can be felt deep in the vaginal canal or outer genitals , can
occur with tampon use .
Signs include cramping , sharp / burning pain, and during
intercourse
Causes of Dyspareunia in Females
Abnormalities in the Uterus such as ulcers/ cysts ( bartholins
cyst )
Injury to the Uterus / vagina
Infection ( uti , yeast infection)
Vaginal dryness/ vaginal atrophy ( after menopause )
Poorly fitted diaphragm / cervical cap
Past surgery
Inflammation ( Vaginitis )
Endometriosis
PID
Being tense prior to intercourse , not enough time for natural
lubrication
Psychological factors : past sexual or physical abuse
Retroverted uterus
Dyspareunia in Males
Peyronies Disease : scar tissue formation that can cause painful
erection and cause penis to bend – resolves on its own or may
require surgery .
Begins with pain and swelling can lead to plaque formation
Infection can cause painful intercourse in men UTI, Yeast

27. infection and STD
Assessment /Treatment for Dyspareunia
Assessment: thorough history and physical of CC and HPI.
Level of pain ? Onset ? Characteristics ? Contributing actors ?
Alleviating factor? Other symptoms? Treatment depends on the
cause
Tx: Antibiotics if infection is present , in post menopausal
women cause may be vaginal dryness from low estrogen levels
and topical options can be prescribed ( osphena )
Desensitization : Kegel exercise
Counseling or sex therapy if cause in psychological
lubrication use during intercourse
Diagnostic test
Pelvic exam
PAP
C/S
Pelvic Ultrasound
References
Andersch, B., & Milsom, I. (1982). An epidemiologic study of
young women with dysmenorrhea. American Journal of
Obstetrics & Gynecology, 144(6), 655-660.
Baranowski, A. P. (2009). Chronic pelvic pain. Best practice &
research Clinical gastroenterology, 23(4), 593-610.
Beard, R. W. (1998). Chronic pelvic pain. BJOG: An
International Journal of Obstetrics & Gynaecology, 105(1), 8-
10.
Coco, A. S. (1999). Primary dysmenorrhea. American family

28. physician, 60(2), 489-496.
Dawood, M. Y. (1990). Dysmenorrhea. Clinical Obstetrics and
Gynecology, 33(1), 168-178.
Glatt, A. E., Zinner, S. H., & McCORMACK, W. M. (1990).
The prevalence of dyspareunia. Obstetrics and gynecology, 75(3
Pt 1), 433-436.
Howard, F. M. (2003). Chronic pelvic pain. Obstetrics &
Gynecology, 101(3), 594-611.
Jamieson, D. J., & Steege, J. F. (1996). The prevalence of
dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel
syndrome in primary care practices. Obstetrics &
Gynecology, 87(1), 55-58.
Meana, M., Binik, Y. M., Khalife, S., & Cohen, D. R. (1997).
Biopsychosocial profile of women with dyspareunia. Obstetrics
& Gynecology, 90(4), 583-589.
References