UNIT-5 NURSING MANAGEMENT OF PATIENTS WITH REPRODUCTIVE SYSTEM.pptx

UNIT-5 NURSING MANAGEMENT
OF PATIENTS WITH DISORDERS
OF FEMALE REPRODUCTIVE
SYSTEM
PREPARED BY:
Mr. Nirmal Vaghela,
Nursing Tutor,
DPCN, Nadiad

ANATOMY AND PHYSIOLOGY OF THE
FEMALE REPRODUCTIVE SYSTEM
 The female reproductive system is designed to carry out
several functions.
 It produces the female egg cells necessary for reproduction,
called the ova or oocytes.
 The female reproductive organs can be divided into the
external genitalia and internal genitalia.

EXTERNAL REPRODUCTIVE ORGANS
 The external genital organs include the mons pubis, labia majora ,
labia minora , Bartholin’s glands and clitoris.
 The area containing these organs is called the vulva.
 The external genital organs have 3 main functions: Sperm enter to the
body , Protecting the internal genital organs and providing sexual
pleasure.
 Mons Pubis: This is the fatty rounded area overlying the symphysis
pubis and covered with thick hairs.

 Labia Majora: The labia majora run posteriorly from the mons pubis.
The labia majora enclose and protect the other external reproductive
organs. The labia majora contain sweat and oil-secreting glands. After
puberty , the labia majora are covered with hairs.

 Labia Minora: The labia minora are 2 smaller folds enclosed by the
labia majora. They lie just inside the labia majora and surround the
openings to the vagina and urethra.
 Clitoris: The clitoris is covered by a fold skin, which is similar to the
foreskin at the end of the penis.
 Perineum: This is the skin covered muscular area between the vaginal
opening and the anus. It aids in constricting the urinary , vaginal and
anal opening. It also helps support the pelvic contents.
 Bartholin’s Glands: Bartholin’s glands lie on either side of the vaginal
opening. They produce mucus substance , which provides lubrication
for intercourse.

INTERNAL REPRODUCTIVE ORGANS
 The internal organs of the female consist of the vagina, cervix, uterus,
fallopian tubes and ovaries.
 Vagina: The vagina is a narrow, muscular but elastic organ about 4 to 5
inches long in adult woman. It connects the external genital organs to the
uterus. It connects the external genital organs to the uterus. It also known
as the birth canal. The vagina is the main female organ of sexual
intercourse. It is located between the bladder and rectum.
 Cervix: The cervix is the lower, narrow portion of the uterus where it joints
with the top end of the vagina. It is cylindrical shape. The cervix surrounds
the opening called the “cervical orifice”, which uterus communicates with
the vagina.

 Uterus: The uterus is a hollow organ about the size and shape of a pear. It
serves 2 important functions: it is the organ of menstruation and during
pregnancy it receives the fertilized ovum, retains and nourishes it until it
expels the fetus during labor.
 Location: The uterus is located between the urinary bladder and rectum. It
is suspended in the pelvis by broad ligaments.
 Divisions of the uterus: The uterus consists of the body, fundus and
isthmus. The major portion of the uterus is called the body. The fundus is
the superior, rounded region above entrance of the fallopian tubes. The
isthmus is the slightly constricted portion that joints the corpus to the
cervix.
 Walls of the uterus: The walls are thick and are composed of 3 layers: the
endometrium, myometrium and perimetrium. The endometrium is the
inner layer, myometrium is the middle layer and perimetrium is the outer
layer.

 Fallopian Tubes: The 2 fallopian tubes, which are about 2 to 3 inches
(about 5 to 7 cm) long, extend from the upper side of the uterus
towards the ovaries. This tube carries eggs and sperm and is where
fertilization of the ovum take a place. The larger end of the tube is
divided into finger like projections called fimbriae, which lie close to
the ovary.
 Ovaries: The ovaries are small, oval shaped glands that are located on
either side of the uterus. The ovaries are for oogenesis- the
production of eggs and for hormone production(estrogen and
progesterone)

MENSTRUAL CYCLE
 Menstruation is the periodic discharge of blood, mucus and epithelial
cells from the uterus.
 The average menstrual cycle takes about 28 days and occurs in phases.
 The menstrual cycle is controlled by the Follicle Stimulating
Hormone(FSH) and Luteinizing Hormone (LH) from the anterior
pituitary and progesterone and estrogen from the ovaries.
 FSH is primarily responsible for stimulating the ovaries to secrete
estrogen.
 LH is primarily responsible for stimulating progesterone production.

 The menstrual cycle can be divided into the following parts: ovarian cycle
and uterine cycle.
 Ovarian Cycle: Ovarian cycle involves changes in the ovaries and can be
further divided into 3 phases:
1. Follicular Phase: The follicular phase is the time from the first day of
menstruation until ovulation, when a mature egg is released from the
ovary.
2. Ovulatory Phase: The ovulatory phase occurs around day 14 of the cycle,
in response to a luteinizing hormone(LH) that occurs just before the egg is
released from the ovary.
3. Luteal Phase: The luteal phase is the time from when the egg is released
until the 1 day of menstruation, when female gets period.

 Uterine Cycle: The uterine cycle involves changes in the uterus. It
occurs with the ovarian cycle and is divided into 2 phase:
1. Proliferative Phase: The proliferative phase is the time after
menstruation and up to ovulation. When menstruation is over the
endometrium grows and thickens during this phase to prepare for
the implantation of an embryo.
2. Secretory Phase: The secretory phase is the time after ovulation and
before the start of a woman’s period. Glands within the
endometrium secrete proteins in preparation for a fertilized egg to
implant. If implantation doesn’t occur, the endometrium begins to
break down and the glands stop secreting. The result is shedding of
the lining (endometrium), called “menstruation”.

NURSING ASSESSMENT
 HEALTH HISTORY:
 Following history are taken-
o Menstrual history
o History of pregnancy
o History of exposure to medications
o History of dysmenorrhea and pelvic pain
o History of vaginal discharge and odor or itching
o History of problems with urinary function
o History of problems with bowel or bladder control
o Marital and sexual history
o History of any surgery
o History of chronic illness or disability
o History of genetic disorder

 PHYSICAL ASSESSMENT:
 Physical assessment includes general examination, systematic
examination and gynecological examination.
1. General Examination: General examination includes height, weight,
body build, nutritional status, appearance and color of the skin,
presence of edema and vital parameters.
2. Systematic Examination: Systematic examination includes the
examinations of the cardiovascular, respiratory and neurological
system.
3. Gynecological Examination: Breast examination, abdominal
examination and pelvic examination. Pelvic examination includes
inspection of the external genitalia, vaginal examination, rectal
examination and recto-vaginal examination.

BREAST SELF EXAMINATION
 Breast self examination(BSE) is inexpensive, risk free, private and relatively
simple examination to detect cancer or breast abnormalities.
 Women should be advice to perform monthly breast self examination to
check for any changes in breast.
 BSE should be done same time each month- the best time to do BSE is 5 to
7 days after menstruate ends, when breasts are likely to be tender or
swollen.
 BSE includes inspection and palpation of breasts in both standing and lying
positions.
 In BSE inspection of the breasts in front of the mirror, palpation of the
entire are of the breast using the flat pads of the fingers in specific pattern
and motion and in lying position do this in supine or partial side-lying
position.

 Steps of Breast Self Examination:
Step 1: Stand in front of mirror and check for any changes in the normal
look and feel of breasts, such as dimpling, size difference and nipple
discharge.
Step 2: Inspect four ways: Arms at sides, arms overhead, firmly pressing
hands on hips and bending forward.
Step 3: In lying position lie on back with a pillow under right shoulder
and right hand under head.
Step 4: With the three fingers of left hand make small circular motions,
follow up and down pattern over the entire breast area, under the arms
and up to the shoulder bone, pressing firmly.
Step 5: Repeat using right hand on left breast.

CONGENITAL ABNORMALITIES OF
FEMALE REPRODUCTIVE SYSTEM
 Congenital means present at birth and abnormality could be defined as something
differing from normal.
CONGENITAL ANOMALIES OF THE VAGINA
 TRANSVERSE VAGINAL SEPTUM:
 Transverse vaginal septum is a condition
in which there is a wall of tissue running
horizontally across the vagina. This wall
creates a blockage in the vagina. In most
cases, there is a small hole in the wall of
tissue that allows menstrual blood flow out of the body.

 CAUSES AND RISK FACTORS:
• A transverse vaginal septum is a congenital disorder, meaning it is present
at birth.
• It occurs when the two parts that normally fuse together to create the
vagina don’t join together properly during development of the fetus.
• The cause of this abnormal development is not yet known.
 CLINICAL MANIFESTATIONS:
• Amenorrhea(absence of menstrual period)
• Periods that last beyond the normal 4 to 7 day cycle.
• Abdominal pain, caused by blood collecting
 MANAGEMENT:
• Treatment involves surgery to remove the wall of tissue that is blocking the
vagina, improving menstrual flow and reducing complications with fertility
and pregnancy.

 VERTICAL OR COMPLETE VAGINAL SEPTUM:
 A vertical or complete vaginal septum is a condition in which there is a
wall of tissue running vertically up and down the length of a girl’s
vagina, dividing it into two separate cavities.
 This condition is also known as “ double vagina” or longitudinal
vaginal septum (LVS).
• A complete vaginal septum is a congenital disorder, meaning it is
present at birth.
• It occurs when the two parts that normally fuse together to create the
vagina don’t join together properly during development of the fetus.
• The cause of this abnormal development is not yet known.

• Pain when inserting or removing a tampon
• Menstrual blood that leaks out even when using tampon
• Pain during intercourse
 MANAGEMENT:
• Surgery- The entire septum is removed
and the normal vagina on both side of
the septum are brought together to
create a normal texture to the vagina.

 VAGINAL AGENESIS:
 Vaginal agenesis or absence of the vagina, is a congenital disorder of the female
reproductive tract.
 It occurs when the vagina does not develop fully.
 It affects approximately 1 in every 5,000 female infants.
 CAUSES:
• The exact cause is unknown, but many different congenital conditions are known to lead
to vaginal agenesis.
• Vagina did not grow during embryologic development
• Amenorrhea
• Cramping
• Lower abdominal pain
 TREATMENT:
• Surgery- create vagina to have normal sexual function. The vagina can be made with graft
of skin or with part of the large bowel.

CONGENITAL ANOMALIES OF THE VULVA
 LABIAL HYPOPLASIA:
 Labial hypoplasia is a condition in which one or both sides of a girl’s
labia- the two large folds of fatty tissue covering the vagina- are
smaller than normal.
• The main cause is unknown
• Labia don’t develop normally during puberty.
 MANAGEMENT:
• No treatment is necessary.
• In some cases, done the procedure to reduce the larger side of the
labia to match the smaller side.

 LABIAL HYPERTROPHY:
 Labial hypertrophy is a condition in which one or both sides of a girl’s
labia are larger than normal.
 The condition usually affects the inner labia but it can also affect the
outer labia.
 CAUSES:
• The condition occur when the labia don’t develop normally during
puberty.
• For unclear reasons, one or both labia may grow to larger sizes.
 MANAGEMENT:
• To perform surgical procedure known as a labiaplasty is available to
reduce the labia to a more normal size.

CONGENITAL ANOMALIES OF THE UTERUS
 UTERINE DUPLICATION:
 Uterine duplication is when a girl is born with a double uterus, a uterus
with two separate cavities.
 CAUSES:
• Uterus doesn’t develop properly in the fetus
• Unusual pain before or during a menstrual period
• Abnormal bleeding during a periods
• Infertility or complications during pregnancy or delivery
 MANAGEMENT:
• Treatment is typically not necessary unless the condition causes symptoms
or if a woman is pregnant or trying to get pregnant.

 UNICORNUATE UTERUS:
 Unicornuate uterus is a rare genetic condition in which only one half
of a girl’s uterus forms.
 A unicornuate uterus is smaller than a typical uterus and has only one
fallopian tube.
 This results in a shape often referred to as a “ uterus with one horn”
or a “ single-horned uterus”.

• Uterus doesn’t form properly during fetal development
• Abdominal pain
• Difficulty getting pregnant
• Complications during pregnancy
 MANAGEMENT:
• Specialized care during pregnancy
• Laparoscopic surgery to remove a non-connected hemi-uterus

 SEPTATE UTERUS:
 A septate uterus is when a girl’s uterus has a wall of tissue running
vertically up and down the middle of it, separating the uterus into two
cavities.
 This wall, called a septum, may extend part way down the uterus is
called partial septate uterus or all the way down to the cervix, at the
bottom of the uterus is called complete septate uterus.

• It occurs when the two parts that are not properly join to the uterus
during fetal development.
• Unusual pain before or during periods
• Complications during pregnancy
 MANAGEMENT:
• This does not need to be surgically corrected unless there is recurrent
pregnancy loss.
• Surgery can be performed to remove the wall of tissue.

CONGENITAL ANOMALIES OF THE CERVIX:
 CERVICAL AGENESIS:
 Cervical agenesis occurs when a girl is born without cervix.
 Cervical agenesis usually occurs along with vaginal agenesis, a condition in which a
girl is born without a vagina.
• This occur when the baby’s reproductive system fails to develop fully in the fetal
development.
 CLINICAL MANIFESTATION:
• Failure to start having periods at puberty
• Abdominal pain
 MANAGEMENT:
• Oral contraceptive pills
• Surgery to connect uterus to vagina which either present from birth or has created.

 CERVICAL DUPLICATION:
 Cervical duplication is a rare genetic condition in which a girl is born with two
cervices.
 Often cervical duplication occurs along with condition known as uterine duplication
where the girl has a double uterus.
• The main cause is unknown.
• It occurs when the cervix doesn’t form properly during fetal development.
• Unusual pain before or during period
• Abnormal bleeding
• Infertility or complications during pregnancy
 MANAGEMENT:
• Treatment is typically not urgent unless the condition causes symptoms or if the
women is pregnant or trying to pregnant.

SEXUALITY AND REPRODUCTIVE
HEALTH
 SEXUALITY:
 Sexuality is a complex aspect of our personality and ‘self’.
 Human sexuality is how people experience the erotic and express themselves as
sexual beings.
 Human sexuality has biological, physical and emotional aspects.
 Biologically, it refers to the reproductive mechanisms as well as the basic biological
drive that exists in all species and can encompass sexual intercourse and sexual
contact in all forms.
 Emotional aspects deal with the intense emotions relating to sexual acts and
associated social bonds.
 Physical aspects include physiological or even psychological and sociological aspects
of sexual behavior.

 Sexual function, sexual self-concept and sexual roles and relationship
are important dimensions of sexual health.
 Sexual function refers to the ability of an individual to give and receive
sexual pleasure.
 Sexual self-concept refers to the image one has of oneself as a man or
women and evaluation of that image.
 Sexual role includes body image and the evaluation of one’s body and
self within the context of the culture.
 Sexual relationships are the interpersonal relationship in which one’s
sexuality is shares with another.

 REPRODUCTIVE HEALTH:
 According to WHO, Reproductive health is a state of complete
physical, mental and social well-being and not merely absence of
disease, in all matters relating to the reproductive system and to its
functions and processes.
 Reproductive health implies that people are able to have a satisfying
and safe sex life and that they have the capability to reproduce and
the freedom to decide if, when and hoe often to do so.
 Everyone has the right to enjoy reproductive health, which is a basis
for having healthy children, intimate relationship and happy families.
 Reproductive health problems remain the leading cause of ill health
and death for women of childbearing age worldwide.

SEXUAL HEALTH ASSESSMENT
 Sexual health assessment should include:
• An assessment of any symptoms.
• A sexual history to establish the patient’s risk of having sexually transmitted
disease(STD).
• Determination of the patient’s method of contraception and risk of
pregnancy.
• A review of other sexual health issues to identify opportunities for sexual
health promotion.
 Sexual history taking:
• Number of sexual partners within the last 12 months
• Gender of partner
• Type of sexual contact( genital, oral or anal)

• Use of barrier methods of contraception, particularly condoms
• Duration of relationship
• Risk factors of partners(STD)
• Date of last sexual intercourse and last unprotected sexual intercourse
• Previous history of STD and treatment required
• General medical and surgical history
• For women, contraceptive use, date of last menstrual period, usual
length of menstrual cycle
• History of pregnancy
• Any other sexual health concerns the patient would like to discuss.

DYSMENORRHEA
 Dysmenorrhea is a menstrual condition characterized by severe and frequent
menstrual cramps and pain associated with menstruation.
 Pain may occur with menses by 1 to 3 days.
 Pain tends to peak 24 hours after onset of menses and subside after 2 to 3 days.
 While most women experience minor pain during menstruation, dysmenorrhea is
diagnosed when the pain is so severe as to normal limits or requires medication.
 TYPES OF DYSMENORRHEA:
• Primary Dysmenorrhea: it begins soon after pre-teen or teen starts
having periods.
• Secondary Dysmenorrhea: secondary dysmenorrhea is a caused by another
medical problem such as pelvic inflammatory disease, uterine fibroids, cervical
narrowing, ovarian tumors.

 CLINICAL MANIFESTATIONS:
• Painful periods
• Cramping in lower abdomen
• Pain in lower abdomen and lower back
• Nausea and vomiting
• Fatigue
 DIAGNOSTIC EVALUATIONS:
• History collection
• Physical examination
• Blood test
• Ultrasonography or MRI
• Hysteroscopy (Visual examination of the uterus through vagina)
 MANAGEMENT:
• Antiprostaglandin drugs
• Oral contraceptives and analgesic drugs

AMENORRHEA
 Amenorrhea is the medical term for the absence of menstrual periods,
either on permanent or temporary basis in a woman of reproductive age.
 Amenorrhea are seen in pregnancy and lactation, during childhood and
during menopause.
 CLASSIFICATION OF AMENORRHEA:
• Primary Amenorrhea: Primary Amenorrhea is the absence of menstrual
bleeding and secondary sexual characteristics( For example, breast
development and pubic hair) in a girl by age 14 years.
• Secondary Amenorrhea: Secondary Amenorrhea is the absence of
menstrual bleeding in women who had been menstruating but later stop
menstruating for 3 or more months in the absence of pregnancy, lactation
or menopause.

 CAUSES AND RISK FACTORS:
1. Natural amenorrhea
2. Repeated use of contraceptives
3. Medications(Antipsychotics, cancer chemotherapy, Antidepressants etc.)
4. Life style factors(Excessive exercise, low body weight)
5. Hormonal imbalance
6. Structural problems of reproductive organs
• Absence of menstrual periods
• Milky nipple discharge
• Hair loss
• Headache
• Vision changes
• Excessive facial hair
• Pelvic pain and vaginal dryness

• Blood test
• Ultrasonography or MRI
• Hysteroscopy (Visual examination of the uterus through vagina)
 MANAGEMENT:
• To give Dopamine agonist( restores normal ovarian endocrine function
and ovulation
• Hormone replacement therapy
• Oral contraceptives (restore menstrual cycle and level of estrogen)
• In genetic or anatomical abnormalities to perform surgery

PREMENSTRUAL SYNDROME
 Premenstrual Syndrome(PMS) refers to a wide range of symptoms that
start during the second half of the menstrual cycle the time after
ovulation and before menstruation.
 Symptoms go away 1-2 days after the menstrual period starts.
o the main cause is unknown but it is probably due to a range of
metabolic factors influenced by hormones.
o Up to 3 out of 4 women experience PMS symptoms during their
childbearing years.

• The symptoms are seen in body, mind and spirit.
• Body: fluid retention and edema, fatigue, joint or muscles pain, headache, weight
gain, bloating, breast tenderness, changes in appetite, constipation or diarrhea.
• Mind: poor concentration, insomnia, depression etc.
• Spirit: anxiety, crying spells, mood swings and irritability or anger, social withdrawal,
felling's of sadness or hopelessness.
• To ask the patient keep a daily diary of symptoms at least 3 months. Record the
type of symptoms you have, how severe they are and how long they last. This
symptoms diary will help in the best treatment.
 MANAGEMENT:
• To provide diuretics, Analgesics, Oral Contraceptive, Antidepressants, etc.

MENORRHAGIA
 Menorrhagia is the most common type of abnormal uterine bleeding
characterized by heavy and prolonged menstrual bleeding.
 In normal menstrual cycle bleeding lasting an average of 5 days and total
blood flow between 25 to 80 ml.
 Blood loss of greater than 80 ml or lasting longer than 7 days it constitutes
“Menorrhagia” or “Hypermenorrhea”.
• Hormonal Imbalance
• Dysfunction of the ovaries
• Uterine fibroids
• Pregnancy Complications
• Some medications

• Every hour changing sanitary pads
• Use double sanitary protection to control menstrual flow
• Needing to wake up for change sanitary protection during night
• Bleeding for longer than a week
• Passing blood clots with menstrual flow for more than one day
• Symptoms of anemia
• Pelvic and rectal examination
• Pap smear
• Blood test
• Endometrial biopsy
• Hysteroscopy
• Ultra sonography

 MANAGEMENT:
• Iron supplements
• Oral contraceptives
• Oral Progesterone
• Dilation and curettage(D and C) procedure
• Hysterectomy- removal of uterus

METRORRHAGIA
 Metrorrhagia is the type of abnormal uterine bleeding diagnosed when
menstruation occurs at irregular intervals.
 The amount of blood loss during menstruation and the number of days vaginal
bleeding occurs are not excessive in patients who have metrorrhagia.
• Hormonal Imbalance
• Stress
• Birth control medications
• Malnourishment
• Fertility treatment
• Light to heavy bleeding between menstrual periods
• Cramping and lower abdominal pain

• Pelvic and rectal examination
• Blood test
 MANAGEMENT:
 Hormonal replace therapy
 Antibiotic
 Analgesic

OOPHORITIS
 Oophoritis, which means inflammation and infection of the ovary.
 The infection of the ovary is the major cause of female infectious morbidity, ectopic
pregnancy.
 Oophoritis most commonly occurs in women younger than 25 years.
• Pelvic inflammatory disease
• Chronic infection in the body
• Salpingitis(inflammation & infection of fallopian tube)
• Unprotected sexual intercourse
• Multiple sexual partner
• Smoking
• stress

• Severe lower abdominal pain
• Heavy vaginal bleeding during menstruation
• Pain during sexual intercourse
• Lower back pain
• High Fever with chills
• Vaginal discharge
• Pelvic examination
• Blood test and Urine test
• Ultrasonography or CT Scan or MRI
• Hysteroscopy (Visual examination of the uterus)

 MANAGEMENT:
• Antibiotics(ceftriaxone, ofloxacin etc.)
• Oophoritis may be managed with surgery when medical
treatment has no reduce the symptoms after 48-72 hours.
• In the surgery may include laparoscopy with drainage of the
abscess present in the ovaries.

OVARIAN CYSTS
 Ovarian cysts are small fluid-filled sacs that develop in a women’s ovaries.
 Most ovarian cysts present little or no discomfort and are harmless, but
some way cause problem such as bleeding and pain that time require a
surgery.
 The majority of ovarian cysts disappear without treatment within a few
months.
 Ovarian cysts are very common, particularly in women between the ages of
30 to 60 years.
 They may be single or multiple and can occur in one or both ovaries.
 Most are benign(non-cancerous) but approximately 15% are
malignant(cancerous).

• History of previous ovarian cysts
• Irregular menstrual cycles
• Increased upper body fats
• Menstruation starting in early age(11 years or younger)
• Infertility
• Breast cancer
• Pelvic pain
• Menstrual changes: Late periods and irregular periods
• Increased facial hair and body hair
• Weight gain
• Severe menstrual cramping
• infertility

 MANAGEMENT:
• Hormonal replacement therapy
• Analgesics
• Surgery
1. Ovarian cystectomy- Removal of cyst without removing the ovary
2. Partial oophorectomy- Removal of the cyst and a portion of the ovary

OVARIAN HYPERSTIMULATION
SYNDROME (OHSS)
 Ovarian hyperstimulation syndrome(OHSS) is the combination of
increased ovarian volume, due to the presence of multiple cysts and
vascular hyperpermeability which means that the blood vessel wall
allows molecules to flow in and out of the vessel.
• Polycystic ovary disease(PCOD)
• Younger women are at greater risk
• High estrogen levels and a large number of follicles
• Use of human chorionic gonadotrophin (hCG) drug

• Weight gain
• Increased abdominal girth
• Decreased urine output
• Shortness of breath

 MANAGEMENT:
• Naturally reverse to normal, so carefully monitor the patient
• Analgesics
• No need of any surgery

OVARIAN TORSION
 Ovarian torsion is a condition that occur when an ovary twists around the
ligaments that hold it in place.
 This twisting can cut off blood flow to the ovary and fallopian tube.
 Ovarian torsion can cause severe pain and other symptoms because the
ovary is not receiving enough blood.
 Ovarian torsion usually affects
only one ovary.
 Ovarian torsion is a medical
emergency.
 If not treated quickly, it can
result in loss of an ovary

• Women's between the ages of 20 to 40 years
• Post menopause period
• Longer ovarian ligaments
• Sudden and sharp lower abdominal pain
• Continuous lower abdominal pain

 MANAGEMENT:
• Oophorectomy: removal of ovary
• Salpingo-Oophorectomy: removal of fallopian tubes and ovaries

OVARIAN CANCER
 Ovarian cancer is a disease produced by the rapid growth and division of the
cancerous cells within one or both ovaries.
 When growth control is lost and cells divide too much and too fast, a cellular mass
or tumor is formed.
• Women older than age 65
• Family history of ovarian cancer
• Use of fertility drugs
• Personal history of cancer
• Obesity
• Hormonal therapy

• Abnormalities in menstruation
• Abnormal hair growth
• Pain with intercourse
 MANAGEMENT:
• Chemotherapy, radiation therapy, hormonal therapy

 MANAGEMENT:
• Chemotherapy
• radiation therapy
• hormonal therapy

SALPINGITIS
 Salpingitis is an infection and inflammation in the fallopian tubes.
 When inflammation occurs, extra fluid secretion or pus collects inside
the fallopian tube.
 Salpingitis is one of the most common cause of female infertility.
 If salpingitis is not properly treated, the infection may permanently
damage the fallopian tube.

• Pelvic inflammatory disease
• Chronic infection in the body
• oophoritis(inflammation & infection of ovary)
• Unprotected sexual intercourse
• Multiple sexual partner
• Smoking
• stress
• Heavy, foul-smelling vaginal discharge
• Dysmenorrhea(painful periods)
• Abnormal menstrual bleeding
• Painful sex intercourse
• Lower back pain
• Fever with chills

• Salpingography: an x-ray scan of the fallopian tubes
 MANAGEMENT:
• Antibiotics(ceftriaxone, ofloxacin etc.)
• salpingitis may be managed with surgery when medical treatment has
no reduce the symptoms after 48-72 hours.
• In the surgery may include laparoscopy with drainage of the abscess
present in the fallopian tubes.

HEMATOSALPINX
 Hematosalpinx is a medical condition involving accumulation of blood into
the fallopian tubes.
• Inflammation of the fallopian tubes
• Fallopian tube torsion
• Cancer of the fallopian tubes
• Severe abdominal pain
• Fever
• Frequent urination

 MANAGEMENT:
• Antibiotics
• Salpingectomy- Removal of the fallopian tube

HYDROSALPINX
 Hydrosalpinx is a blocked fallopian tube filled with serous or clear fluid
 Hydrosalpinx occurs when fluid is collected at the end of fallopian
tube near the ovary.
 This condition is occur in one or both fallopian tubes.
 The blocked tubes cause infertility.
• Inflammation of the fallopian tubes
• Fallopian tube torsion
• Cancer of the fallopian tubes
• Pregnancy

• Severe abdominal pain
• Foul smell vaginal discharge
• High Fever
• Frequent urination
• Laparoscopy
 MANAGEMENT:
• Antibiotics

FALLOPIAN TUBE CANCER
 Fallopian tube cancer is a disease produced by the rapid growth and
division of the cancerous cells within one or both fallopian tubes.
 When growth control is lost and cells divide too much and too fast, a
cellular mass or tumor is formed.
• Postmenopausal women's age of 50 to 60 years
• Long term inflammation of the fallopian tubes
• Infertility
• Family history of fallopian tube cancer

• Irregular or heavy vaginal bleeding, especially after menopause
• Abdominal pain
• Abnormal vaginal discharge
• Laparoscopy

 MANAGEMENT:
• Chemotherapy
• Radiation therapy
• Hormone therapy

ENDOMETRIOSIS
 Endometriosis is the abnormal growth of endometrial cells outside the uterus most
commonly on the ovaries.
 This endometrium cells are found on the ovaries, fallopian tubes and outer surface
of the fallopian tubes.
 Endometriosis affects 10% to 15% of women and is chronic, sometimes painful
condition that can lead to infertility.
• Retrograde Menstruation: Retrograde Menstruation(also known as “reverse
menstruation”) occurs when blood and endometrial tissue back up into the
fallopian tubes.
• Congenital condition
• Hormonal imbalance
• Genetic

• Chronic pelvic pain
• Infertility
• Dysmenorrhea(painful menstruation)
• Irregular or heavy menstrual bleeding
• Painful sexual intercourse
• Blood in urine
• Laparoscopy

 MANAGEMENT:
• Analgesics
• Hormone therapy
• Hysterectomy-Removal of the uterus

UTERINE POLYPS
 Uterine polyps or Endometrial polyps are growths attached to inner wall of the
uterus and protruding into the uterine cavity.
 Overgrowth of cells in the lining of the uterus leads to the formation of uterine
polyps.
 They are attached to the uterine
wall by a large base.
• Obesity
• History of cervical polyps
• hypertension

• Irregular menstrual bleeding
• Heavy bleeding during menstruation
• Vaginal bleeding after menopause
• Infertility
• hysteroscopy
• Laparoscopy

UTERINE FIBROIDS
 Uterine fibroids are abnormal growths or benign tumors that originate
in the tissue of the uterus.
 Uterine fibroids are common and occur in about 40% of women by the
age of 40.
 Uterine fibroids develops in
the muscular wall of the uterus.

• Obesity
• Heredity
• Smoking
• Painful bowel movements
• Infertility
• Lower back pain
• Heavy menstrual bleeding
• Pregnancy complications

• hysteroscopy
• Laparoscopy
 MANAGEMENT:
• Analgesics
• Hysterectomy- Removal of uterus
• Myomectomy- Removal of uterine fibroids without damaging healthy
tissue

UTERINE CANCER
 Uterine cancer or endometrial cancer is the most common gynecological cancer.
 It develops in the body of the uterus, which is a hollow organ located in the lower
abdomen.
 Uterine cancer is defined as a abnormal cancerous cells growth in the uterus.
• Age more than 50 years
• Family history of uterine cancer
• Personal history of breast or ovarian cancer
• Obesity or hypertension

• Any bleeding after menopause
• Prolonged periods
• Non bloody vaginal discharge
• Pelvic pain
• hysteroscopy
• Pap test

 MANAGEMENT:
• Surgical treatment: hysterectomy-Removal of uterus
• Hormone therapy
• chemotherapy

UTERINE PROLAPSE
 Uterine prolapse or Uterine displacement is a condition in which women’s uterus
slips out of its normal position.
 Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and
weaken, providing inadequate support for the uterus.
 The uterus then descends into the vaginal canal.
• Pregnancy
• Childbirth
• Hormonal changes after menopause
• Obesity
• Severe coughing
• Loss pelvic muscle tone

 TYPES OF UTERINE PROLAPSE:
1. First-degree prolapse: occurs when the uterus downward into the
upper vagina.
2. Second-degree prolapse: occurs when the cervix is at or near the
outside of the vagina.
3. Third-degree prolapse: occurs when the entire uterus is outside the
vagina.

• Pressure in the pelvis
• Pain the pelvis
• Protrusion of vaginal tissue
• Lower back pain
• Constipation
• Difficulty with urination

 MANAGEMENT:
• Special exercises, called Kegel exercises, can help strengthen the pelvic
floor muscles.
• Vaginal pessary: a pessary is a rubber or plastic device that fits around
or under the lower part of the uterus, helping to support the uterus
and hold it in place.
• Hysterectomy- Removal of uterus

CERVICAL POLYPS
 Cervical polyps are smooth, red, finger-shaped growths in the passage
extending from the uterus to the vagina(cervical canal).
 They occur most often during pregnancy because of hormonal
changes.
 In some cases, cervical polyps can block the cervix and cause problems
getting pregnant.
 Cervical polyps are non-cancerous.

• Any infection in pelvic area
• Long term inflammation in pelvic area
• Congestion of blood vessels
• Women’s age older than 20 years
• Multiple pregnancy
• Bleeding after sexual intercourse
• Abnormal heavy bleeding
• Bleeding after menopause
• Watery and bloody discharge from vagina

 MANAGEMENT:
• Antibiotic
• Polyps do not need to be removed unless they bleed are very large or
have an unusual appearance.
• Large polyps can be removed by surgical procedure

CERVICAL CANCER
 Cervical cancer develops in the lining of the cervix, the lower part of
the uterus that enters the vagina.
 Mostly 80-90% cervical cancer develops in flat, scaly surface cells that
line the cervix.
 Cervical cancer is the second most
common malignancy in women
worldwide and it remains a leading
cause of cancer related death for
women in developing countries.

• Previous infection with human papillomavirus(HPV)
• Early sexual contact
• Multiple sexual partners
• Smoking
• Taking oral contraceptives
• Abnormal vaginal bleeding
• Thin watery vaginal discharge after intercourse
• Pelvic and lower back pain
• Painful urination
• Weight loss

• Pap test
 MANAGEMENT:
• Radical trachelectomy- removes cervical tissue that contain cancer
cells
• Chemotherapy

CYSTOCELE, URETHROCELE
AND RECTOCELE

CYSTOCELES AND URETHROCELE
 Cystoceles occurs when the supportive tissue between a woman’s
bladder and vaginal wall weakness and stretches, allowing the bladder
to bulge into the vagina.
 Cystocele may also be called a prolapsed bladder.
 An Urethrocele is the prolapse of the female urethra into the vagina.
 Weakness of the tissues that hold the urethra in place cause it to
move and to put pressure on the vagina, leading to the descent of the
anterior distal wall of vagina.

• Pregnancy and multiple vaginal childbirth
• Imbalance of estrogen levels
• Menopause
• Weakness of pelvic muscles
• Incontinence of urine
• Recurring urinary tract infections (UTIs)
• Feeling of fullness or pressure in pelvis and vagina
• Pain or urinary leakage during sexual intercourse
• Urination problems

 MANAGEMENT:
• Activity changes: Avoiding certain activities, such as heavy lifting or
straining during bowel movements, that could cause the cystocele.
• Kegel exercise
• Pessary : This is a device placed in the vagina to hold the bladder in place
• Surgery: May be used to move the bladder back into a more normal
position.

RECTOCELES
 A rectocele occurs when the thin wall of fibrous tissue separating the
rectum from the vagina becomes weakened, allowing the front wall of
the rectum to bulge into the vagina.
 A small rectocele may cause no signs or symptoms. If a rectocele is
large, it may create a bulge of tissue through the vaginal opening.

• Pregnancy and childbirth
• Weaked vaginal muscles
• Imbalance of estrogen
• Obesity
• Multiple births
• Large pelvic tumors
• Soft bulge of tissue in vagina that may or may not protrude through the
vaginal opening
• Difficulty having a bowel movement
• Sensation of rectal pressure
• constipation

• Pelvic and rectovaginal examination
 MANAGEMENT:
• Pessary- A vaginal pessary is a plastic or rubber ring inserted in the
vagina to support the bulging tissues.
• Surgery- surgery usually consists of removing excess, stretched tissue
that forms the rectocele.

VAGINITIS
 Vaginitis is a infection and inflammation of the vagina.
 Vaginal infection caused by organisms such as bacteria, yeast or
viruses.
• Recent treatment with antibiotics
• Uncontrolled diabetes
• Hormonal changes
• Oral contraceptives
• Thyroid or endocrine disorders

• Unusual vaginal discharge
• Changes in the amount, color or odor of vaginal discharge
• Itching and irritation in the vaginal area
• Pelvic and examination
• Pap test
 MANAGEMENT:
• For bacterial vaginitis to give antibiotic tablets or vaginal gel.
• For fungal infection to provide anti fungal treatment

VAGINAL FISTULA
 Fistula is an abnormal opening between two internal organs.
 Vaginal fistula is an abnormal passage that connects the vagina to
other organs, such as the bladder or rectum.
• Rectal damage
• Crohn’s disease
• Inflammation in the bowel
• Perineum tear after childbirth
• Surgery of the vagina and anus
• Inflammation in the abdomen

• Pus from vagina
• Vaginal irritation
• Foul-smelling vaginal discharge
• Recurrent vaginal or urinary infections
• Pain in the vagina
• Inability to control bowel movement
• Leakage of urine into the vagina
• Pelvic and rectovaginal examination

 MANAGEMENT:
• Antibiotics
• Through the surgery remove the fistula tract and close the opening
together healthy tissue around.

VAGINAL DISCHARGE
 Vaginal discharge refers to secretions from the vagina, such
discharge can vary in consistency(thick, pasty, thin),
color9clear,cloudy, white, yellow, green) and smell (normal,
odorless, bad odor).
 Fluid made by glands inside the vagina and cervix carries away
dead cells and bacteria.

• Antibiotic or steroid use
• Vaginitis
• Birth control pills
• Cervical or vaginal cancer
• Diabetes
• Pelvic infection
• Sexually transmitted disease
• Changes in color, consistency or amount of vaginal discharge
• Increased vaginal discharge
• Presence of itching
• Vaginal burning during urination
• Foul odor vaginal discharge

 MANAGEMENT:
• Cleaning the genital area with mild soap and warm water may help to
reduce odor.
• For yeast infections, using antifungal medications may help to reduce
itching and other symptoms
• To prevent further irritation such as a soaps and hygiene sprays.

VULVITIS
 Vulvitis is an inflammation of the vulva, the soft folds of skin outside
the vagina.
 Women who experience excessive stress, whose nutrition is poor or
who have poor hygiene may be more susceptible to vulvitis.
• Allergy to a vaginal spray
• Excess moisture in genital area
• Fungal or bacterial infection
• Long term dermatitis
• Swimming pool water

• Redness and swelling on the labia and other parts of the vulva
• Itching
• Whitish patches on the vulva
• Pap test

 MANAGEMENT:
• Cleaning the genital area with mild soap and warm water may
help to reduce odor.
• For yeast infections, using antifungal medications may help to
reduce itching and other symptoms
• To prevent further irritation such as a soaps and hygiene sprays.

VULVAR CANCER
 Vulvar cancer is an uncommon cancer of the outer surface area of the
female genitalia.
 Vulvar cancer most common affects the outer vagina less often inner
vagina.
• Women’s older than 70 years
• Human papillomavirus (HPV) infection
• Smoking
• HIV

• Tumor in the vulva
• Itching
• Bleeding
• Tenderness in the vulvar area
• Pain
• Thickening skin of the vulva
• Biopsy

 MANAGEMENT:
• Radical vulvectomy- removes cervical tissue that contain cancer cells.
• Chemotherapy

BARTHOLIN’S GLAND CYSTS
 Bartholin’s gland cysts are mucus-filled sacs that can form when the glands located
near the opening to the vagina are blocked.
 Bartholin’s glands are very small, round glands that are located in the vulva on
either side of the opening to the vagina.
 These glands may help provide fluids for lubrication during sexual intercourse.
 If the duct to the gland is blocked, the gland
becomes filled with mucus and enlarges
 These cysts develop in about 2 % of women,
usually those in their 20 years age.
 The cause is unknown.
 Rarely, cysts result from a sexually transmitted
disease, such as a gonorrhea

• Discomfort during sitting, walking or sexual intercourse
• Pain
• Fever
• Tenderness
• Biopsy
 MANAGEMENT:
• Antibiotics
• Surgical drainage

SKENE’S DUCT CYST
 Skene’s duct cysts develop near the opening of the urethra when the
ducts to the glands are blocked.
 Skene’s glands also called periurethral glands are located around the
opening of the urethra.
 The main cause is unknown.
 These cysts occur mainly in adults.
 Infection and inflammation can cause blockages in the duct.

• Urination problem
• Urinary tract infection
• Painful urination
• Tenderness
• Biopsy
 MANAGEMENT:
• Antibiotics
• Surgical drainage

DEFORMITIES OF BREASTS
 Deformities of breasts are congenital breast deformity where the
breasts appear more tubular or triangular, rather than the round
shape.
 Breast deformities are the deformity in the growth of the breasts, such
as asymmetry, underdevelopment and massive overgrowth.
 TYPES OF BREAST DEFORMITIES:
 TUBULAR BREAST DEFORMITY:
• This is a congenital breast deformity appear more tubular or triangular
rather than the round normal shape.

 PECTUS CARINATUM:
• This is a more of a problem with the sternum, rather than the breasts, but
it certainly causes a breast deformity.
• In this type of breast deformity the sternum is unnaturally bowed outward
and making the breasts appear “pigeon chest”.
 BREAST ASYMMETRY:
• Breast asymmetry is a real congenital deformity that can occur when the
breasts are significantly different in size from one another.
 PECTUS EXCAVATUM:
• The exact opposite of pectus carinatum, pectus excavatum occurs when the
sternum is bowed inward.
• This can also affect the ribs as well as the breasts and the internal organs.
• This will make breasts appear more “concave” meaning they cave inwards
and have a weak inner structure.

MASTITIS
 Mastitis is an infection of the tissue of the breast that occurs most
frequently during the time of breastfeeding.
 This infection cause pain, swelling, redness and increased temperature
of the breast.
 This causes infection and painful inflammation of the breast.
 Breast infection that leads to an abscess(collection of pus) is more
serious type of infection.
 If mastitis is untreated the abscess can develop in the breast tissue.

• Breast feeding
• Hormonal changes
• Bacterial infection in the breast
• Crack nipple
• Diabetes
• HIV or AIDS
• Breast pain
• Discharge from the nipple
• Burning sensation in the breast
• Breast is warm or hot to the touch
• Tenderness and swelling present in the breast
• Change breast shape
• Fever and chills

• Breast examination
• Mammography
• Biopsy
 MANAGEMENT:
• Antibiotics
• Analgesics
• Surgical drainage-drained the abscess

BREAST CYSTS
 Breast cyst is a fluid-filled sac within the breast.
 Breast cysts usually feels like a water filled balloon.
 Breast cysts are common in women 30 to 40 years age.
• Emotional stress
• Injuries in the breast
• Abortion
• Improper diet
• Overweight
• Oral contraceptives use
• Smoking and alcohol consumption

• Smooth, easily movable round cyst feel in the breasts
• Breast pain
• Tenderness in breasts
• Discharge from the nipple
• Change breast shape
• Fever and chills
• Mammography
 MANAGEMENT:
• Antibiotics
• Analgesics
• Surgical drainage-drained the fluid present in the cyst

FIBROCYSTIC BREAST DISEASE (FBD)
 Fibrocystic breasts are characterized by lumpiness and usually
discomfort in one or both breasts.
 This condition affects more than 60% women's.
 This condition primarily affects women's between the ages 30 to50
years.

• Excessive caffeine intake
• Take high fat diet
• Obesity
• Tenderness in one or both breasts
• Breast pain or discomfort
• Swelling in the breasts
• Nipple discharge

 MANAGEMENT:
• Analgesics

BREAST CANCER
 Breast cancer is an uncontrolled growth of breast cells.
 Breast cancer refers to a malignant tumor that has developed from
cells in the breast.
 Breast cancer occurs anywhere in
the breast, but most are found in
the upper outer side where most
breast tissue is located.

• Family history
• Menopause after age 55
• Oral contraceptives use
• Overweight after menopause
• Lake of physical activity
• Changes size and shape of the breasts
• Skin of the breasts are red and swelling
• Tenderness in breast
• Nipple discharge
• Nipple turned inward

• Biopsy
• Ultrasound or CT-Scan or MRI
• Mammography
 MANAGEMENT:
• Lumpectomy- remove lump and surrounding tissue in the breast
• Chemotherapy

CONTRACEPTION
 Strategies And devices which are reduce the risk of fertilization of
ovum by a sperm can be referred to as contraception.
 Contraception is the use of artificial or natural means to prevent
conception or pregnancy.
 TYPES OR METHODS OF CONTRACEPTION:
• There are various types of contraception used as birth control
methods.
• The most common artificial methods are male/female condoms,
spermicides, diaphragm, cervical cap, oral contraceptives, injectable
contraceptives, vaginal rings, intrauterine devices(IUDs) and surgical
sterilization.

A. NATURAL METHODS:
 The safest and easiest way to prevent pregnancy.
• Following methods are available to avoid pregnancy without use of
any artificial means of birth control.
1. BREAST FEEDING:
• After childbirth it takes some time such as few months in most cases,
for the women to start menstruating again and ovulation to occur.
• This period during breast feeding when there is an absence of
menstruation is termed lactational amenorrhea.
• During lactational amenorrhea the chances of getting pregnant are
reduced.

2. THE RHYTHM (CALENDAR) METHOD:
• According to this method a woman is considered fertile after 10 days of the
start of the menstrual cycle that time sexual intercourse is avoided during
these 10 days.
• The ‘safe period’ is considered to be the week during, before and after
menstruation.
• The rhythm method assumes that all women have 28 days cycles and that
ovulation occurs in the middle of the month.
3. CERVICAL MUCUS/BILLINGS OVULATION METHOD:
• Cervical mucus or billings ovulation method is the cervical mucus method is
based on careful observation of mucus patterns during menstrual cycle.
• Before ovulation, cervical secretions change- creating an environment that
helps sperm travel through the cervix, uterus and fallopian tubes to the
egg.
• By recognizing changes in cervical mucus, to pinpoint when you are likely to
ovulate.

4. BASAL BODY TEMPERATURE:
• A women can also note her body temperature at the same time early every
morning is called basal body temperature.
• Ovulation may cause a slight increase in basal body temperature.
• Most fertile during the 2 to 3 days before temperature rises.
• By tracking basal body temperature each day it may help you determine
when most likely to conceive and avoid sexual intercourse during this time.
5. COITUS INTERRUPTS/WITHDRAWAL:
• Withdrawal or coitus interrupts is the practice of withdrawing the penis
from the vagina before ejaculation occurs.
• Withdrawal is not effective method because the timing can go wrong and
contact with the vagina a small amount of sperm is cause pregnancy.

6. OUTER COURSE:
• Sexual expression aside from intercourse can take a variety of form
including oral sex, anal sex, hugging etc.
• The avoidance of penile-vaginal intercourse as a contraceptive technique is
most successful when a couple can communicate effectively about sexual
matters.
• The contraceptive effectiveness of this approach depends on the couple’s
attitudes and self-control to refrain from penile-vaginal intercourse.
7. ABSTINENCE:
• Abstinences means different things to different people.
• Abstinences refers to not having penis-in-vagina intercourse.
• For protection against infection, abstinence means avoiding vaginal, anal
and oral-genital intercourse.
• Some people will use other kinds of touching to satisfy their needs.

B. BARRIER METHODS
1. MALE CONDOM:
• Condoms act as a mechanical barrier they prevent pregnancy and
reproductive tract infections by stopping sperm from going into the vagina.
• They should be placed on the penis before it enters a partner’s vagina.
• Condoms are made of latex, plastic or natural membranes.
• Male condoms are considered to be between 85-98% effective.
2. DIAPHRAGM:
• Diaphragm is a circular, dome-shaped rubber disc inserted into the vagina
to cover the cervix and block the entrance of sperm.
• Diaphragm is available in different sizes ranging from 2 to 4 inches,
depending on the size of the upper vagina.
• Afterwards it is removed washed with soap and water, thoroughly dried
and kept away until the next use.

3. CERVICAL CAP:
• Cervical cap is a small, bowl-shaped device that fits over the cervix.
• The dome of the cap fits over the cervix and preventing sperm from
entering.
• Cervical caps are less effective in women who had vaginal delivery.
4. FEMALE CONDOM:
• Female condom is a soft, loose-fitting sheath made of polyurethane closed
at one end.
• It works by blocking the release of sperm into the vagina.
• The condom is inserted into the vagina before sexual intercourse.
• The closed end of the female condom is inserted into the vagina and open
end lies outside the vaginal opening.
• The female condom can be inserted up to 8 hours before intercourse.

5. SPERMICIDES:
• Spermicides are chemicals applied into the vagina, which work by
inactivating or killing the sperms.
• They are available in the form of tablets, jellies and creams.
• The spermicides is inserted into the vagina with the help of plastic plunger-
type applicator immediately before sexual intercourse.
• Spermicides failure rate is 29%.
6. VAGINAL SPONGE:
• Vaginal sponge is a small, circular, polyurethane sponge that contain 1 gram
of nonoxynol-9 spermicide.
• The sponge is use only one time.
• The sponge has a dimple on one side that fits over the cervix that absorbs a
sperm and preventing them from entering cervix.
• The failure rate is 20%.

7. NON-HORMONAL INTRAUTERINE DEVICE:
• Intrauterine devices(IUDs) are placed inside the uterus to prevent
fertilization.
• These contraceptive methods have a high rate of effectiveness, a
relatively low risk of side effects and are readily reversible by removal
of the device.
• The copper T IUD is a small, T-shaped device.
• The device has 2 flexible arms that fold down for insertion and expand
to a T shape when released inside the uterus.
• The device is 36mm tall and 32mm wide.
• Failure rate is 0.6%.

C. HORMONAL METHODS
 Hormonal methods work by influencing the hormones estrogen and
progesterone in the body and thereby stopping ovulation or sperm
production.
 Hormonal methods disturb balance of hormones in the body.
 The risks and side effects of hormonal methods is imbalance periods,
nausea and vomiting, mood swings, headache etc.
1. ORAL CONTRACEPTIVES:
• Birth control pills also called oral contraceptives, contain hormones
like estrogen and progesterone.
• Birth control pills are specially designed to control the hormone levels
of the woman.
• If taken correctly and daily, success rate is close to 100%.

• There are 2 types of birth-control pills available:
 Combined Oral Contraceptive:
 Combination pill contains the hormones estrogen and progesterone.
 When a woman uses the combination pill, the eggs in her ovaries do
not mature and she does not ovulate.
 She does not become pregnant because no egg is available to be
fertilized by a sperm.
 Progesterone-Only Pill:
 While combines oral contraceptives stop ovulation, progesterone-only
pills prevent pregnancy by increasing the cervical mucus and not
properly travel the sperm.
 This type of pills taken everyday.

2. INJECTIBLE CONTRACEPTIVES:
• Depo Provera and Net En are progesterone-only injectable
contraceptives.
• The contraceptive effect of Depo Provera lasts for 3 months and Net
En for 2 months.
• Both are intramuscular and subcutaneous injections.
• Effective rate is 99%.
3. ORTHO EVRA CONTRACEPTIVE PATCH:
• The contraceptive patch has the same properties as the oral birth
control pill, but is applied to the skin of the lower abdomen, buttocks,
upper arm or upper body.
• The effectiveness is 99%.

4. VAGINAL RING:
• Vaginal ring is a flexible transparent ring about two inches wide that is
inserted into the vagina once each cycle.
• The ring is placed into the vagina and left in place for 3 weeks, then
removed for 1 week to allow for period.
• The effective rate is 99%.
5. IMPLANON IMPLANT:
• Implanon is a 4 cm long rod with a core of progestin which is inserted
under the skin of the upper arm.
• The progestin is released slowly and implanon remains effectives for 3
years.
• Implanon is effective because it stops the ovaries from releasing the
egg.

D. PERMANENT METHODS:
• Permanent methods in men and women involve permanent blocking
or cutting off the tubes which carry the egg/sperm.
• Sterilization is very highly effective.
• It is appropriate for people who have attained the desire family size
and are sure that they do not want any more children.
1. TUBECTOMY/FEMALE STERILIZATION:
• Under this method small incision is made in the abdomen to gain
access to the woman’s fallopian tubes that are cut, tied or clipped.
• It blocks the fallopian tubes in the female so that the eggs produced
by the ovaries cannot meet the sperm.
• Female sterilization is very effective method.

 ADVANTAGES:
• Highly effective
• Low risk of side effects
• Freedom from having to remember to use contraceptive method
regularly or at the time of intercourse
• No effect on hormones
• Cost-effective
 DISADVANTAGES:
• Permanent procedures with possible low reversible rate
• Risk of ectopic pregnancy
• Lack of protection against STI

2. VASECTOMY/MALE STERILIZATION:
• Vasectomy is a surgical method of sterilization for men.
• It blocks the vas deferens in the male so that sperms cannot travel to
the penis with semen.
• In this method cut the ends of vas deferens and sealed the ends.
 ADVANTAGES:
• Highly effective
• Low risk of side effects
• Freedom from having to remember to use contraceptive method
regularly or at the time of intercourse
• No effect on hormones
• Cost-effective

 DISADVANTAGES:
• Permanent procedures with possible low reversible rate
• Risk of ectopic pregnancy
• Lack of protection against STI

TOXIC SHOCK SYNDROME
 Toxic shock syndrome is a serious, life threatening illness caused by
toxins released by two specific bacteria streptococcus pyogenes or
staphylococcus aureus.
 It is a medical emergency requiring immediate care.
 This disease frequently linked to use of tampons in menstruating
women, it can affect people of any gender or any age.
 Toxic shock syndrome can occur with skin infections, burns and after
surgery.

• High fever
• Watery diarrhea
• Low blood pressure
• Skin rashes
• Dizziness
• redness of eyes, mouth, throat, vagina
• Blood culture
• Throat and vaginal culture
• Urine test

 COMPLICATIONS:
• Renal failure
• Liver failure
• GI disturbance
• Delusion
• Death
 MANAGEMENT:
• Antibiotics
• Anti emetics
• Fluid and electrolyte supplyment

INJURIES, TRAUMA AND
SEXUAL VIOLENCE

 A genital injury is an injury to male or female sex organs, especially those
outside the body.
 It also refers to injury in the area between the legs, called the perineum.
 Genital injury in young girls may be caused by placing items into the vagina.
 Objects used may include toilet tissue, crayons, beads, pins, or buttons. The
health care provider should ask the girl how the object was placed there.
 It is important to rule out sexual abuse, rape, and assault.
 Falling down directly
 Injuries during bicycling
 Injuries due to forceful penetration during sexual intercourse

 Abdominal pain
 Bleeding
 Affected area has changed in shape
 Object embedded in a body opening
 Pelvic pain
 Swelling
 Urine drainage
 Vomiting
 painful or inability to urinate
 Foul-smelling vaginal discharge

 COMMON GENITAL TRACT INJURIES IN FEMALES
1.Complete perineal tear (CPT)
2.Coital Injuries
3.Injuries to Rape victims
4.Direct trauma
5.Foreign bodies

1.COMPLETE PERINEAL TEAR (CPT):
 Tear of the perineal body involving the sphincter any externus with or
without involvement of the anorectal mucosa is called complete
perineal tear.
 Obstetrical:- Due to perineal tear during delivery.
 Gynaecological:- Due to injury on the perineum by fall may lead to
trauma on the perineum to the extent.
 MANAGEMENT:
 Preventive: Proper conduction of labour and taking great care of
patient during delivery.
 Operative: Sphincteroplasty with restoration of the perineal body.

2.COITAL INJURIES:
 The following are the nature of coital injuries
 Minor haemorrhage due to tearing of the hymen or bruising of the
vagina. No treatment is usually required.
 Severe haemorrhage may occur, if the tear spreads to involve the
vestibule or the region of the clitoris.
 Very rarely, rupture of the vault of the vagina may occur. This usually
occurs in rape, very young girls, postmenopausal atrophy & following
vaginal hysterectomy.

 MANAGEMENT:
• Small tears need no treatment. Only pressure application is
enough.
• Larger lacerations have to be repaired.
• If the vault has ruptures it is preferable to perform a
laparotomy and repair the vault.

3.INJURIES TO RAPE VICTIMS (SEXUAL ASSAULT):
 The victims may be of any age group- pre menopausal, childbearing or
even postmenopausal.
 The very young, mentally and physically handicapped and the very old
are the common victims.
 FORENSIC CONSIDERATION:
• The medico legal issues should be seriously considered even if the
victim does not want to report the case.
• The medical examination and evidences are of value to the court.
• Referral may be through police, hospital doctor or by self referral.
• The physician should examine her as early as possible following rape.

 Due consent is to be taken from the victim and the examination is made in
presence of third party.
 Confidentiality is to be maintained.
 Detailed statements from the victim and examination findings are
recorded.
 Collected materials are labelled properly and should be sent for expert
examination.
 MANAGEMENT:
• Prevent infection and STD
• Prevent pregnancy
• Medico legal procedures
• Provide emotional support
• Follow up

4.DIRECT TRAUMA:
 Accident, as falling on any sharp or pointed object, is common
especially in young girls.
 It may produce bruising of vulva or at times may produce vulval
haematoma.
 Major fall may involve pelvic bone fracture, injuries to the pelvic
viscera like bladder or rectum apart from vagina.
 MANAGEMENT:
• Assessment of general condition and nature & extent of injury.
• Small vulval haematoma, if not spreading may be left alone but if it’s
larger and spreading, it should be tackled under general anaesthesia.
• This includes scooping of the blood clots after giving an incision, and
secure suturing.

5.FOREIGN BODIES:
 Various types of foreign bodies may be placed either in the vagina or
uterus and retained for a prolonged period often unnoticed by the patient.
 The articles so placed are either introduced by the patient or at times by a
physician.
 Such articles are of varying nature as mentioned below.
 IN THE VAGINA:
• Coins, toys, small stones by children
• Forgotten menstrual tampon or diaphragm, cervical cap or condom used as
contraceptive
• Articles introduced to produce abortion
• Packs, swabs or dressings
• Forgotten Pessary

 IN THE UTERUS:
• Retained IUCD for a long time
• Old gauze packs
• Articles inserted to produce abortion
 MANAGEMENT:
 Once diagnosed, the foreign body is to be removed.
 In children it may not be easy and it is better to expose the vagina
under general anaesthesia using nasal speculum.

UNIT-5 NURSING MANAGEMENT OF PATIENTS WITH REPRODUCTIVE SYSTEM.pptx

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