Ch. 26 Female GU Flashcards
Developmental competence: infants
external genitalia engorged because of presence of maternal estrogen
Size recedes in a few weeks.
Developmental competence: childhood
ovaries are in the abdomen rather than the pelvis; move into the pelvis at the time of menarche.
Developmental competence: pregnancy
cervical and vaginal secretions increase during pregnancy.
20-24 weeks—uterus almost to the liver, displacing intestines superiorly and laterally.
During pregnancy—risk of yeast infection
Why do woman have a risk of yeast infection during pregnancy
Increase in glycogen increases risk of candidiasis during pregnancy
Developmental competence: aging women
menopause at 48-51 years—cessation of menses
Ovaries stop producing progesterone and estrogen.
Decreased size of the uterus; ovaries atrophy; uterus droops;
Vagina less elastic; atrophies; decreased secretions
Decreased sexual response; decreased vaginal secretions; decreased duration of orgasm and rapid resolution.
Cultural issues pertaining to woman re GU
female genital mutilation—removal (partial or total) of clitoris
Aboriginal, Christian, Muslims from East and Southern Asia, Middle East, large areas of Africa
Menstrual hx
normal menses q. 28 days; 3-7 days duration
obstetric hx
gravida, para, abortions (interrupted pregnancies)
Menopause ; ask about symptoms
hot flashes, night sweats, numbness and tingling, headaches, palpitations, mood swings. Discuss reaction to loss.
Perimenopause ages?
40-55 y.o.
Acute Pelvic Pain - what does this mean?
acute pain that lasts < 3 months; urgent conditions could be PID, appendicitis, ruptured ovarian cysts, ovarian torsion
Urinary symptoms - what do you ask?
any problems urinating; frequency and small amts; any burning; cloudy or foul?
Vaginal discharge - what to ask
ask about unusual discharge; meds (OCPs or antibiotics); ask about family hx of DM (DM increases glycogen.
Vaginal discharge: possible causes, risks, etc
Can suggest vaginal infection; rash can result from irritation, dypareunia occurs occurs with vaginitis of any cause; oral contraceptives increase glycogen content of vaginal epithelium, providing fertile medium for organisms; broad spectrum antibiotics alter balance of normal flora; frequent douching alters pH; feminine sprays have risk for contact dermatitis
Urinary symptoms possible
Hematuria can occur with UTI or kidney disease; ask about UI b/c most woman wont discuss.
Urinary incontinence - risks associated
UI can decrase quality of life, limit activities, increase fall risk, and fx risk.
Distinguish b/w urge and stress incontinence
Urge: musculature
Stress: physical strain, sneezing, coughing leads to UI
past hx discussion for Female GU
assess feelings. Some ppl fear loss of sexual response after hysterectomy, which may affect intimate relationships.
Sexual hx - why bring it up?
your comfort with discussion prompts person’s interests and possible relief that topic has been introduced.
contraceptive use and smoking - risk?
increased r/o vascular problems
when is infertility considered?
infertility is considered after 1 year of unprotected sex w/o conceiving
STI contact
includes all conditions that can be transmitted during sexual activity
External genitalia - normal obj. findings
skin color even; labia minora should be darker pink.
when would you consider delayed puberty
if there is no pubic hair or breast dev’t by age 13
Dev comp: newborn - normal findings
sanguinous or mucus discharge from vagina is normal during first few weeks b/c of maternal estrogen effect
Dev comp: children - abnormal finding
during or after toddler age—foul-smelling discharge occurs with lodging of foreign body, pinworms, or infection.
Dev comp: adolescents: STI screening - WHEN
1) With history of multiple sexual partners.
2) With previous STI treatment.
3) Chlamydia and gonorrhea screening annually for sexually active adults.
4) Syphilis screening for teens who trade sex for drugs or money, use IV drugs, or live in a high prevalence neighborhood.
Dev comp (objective): adolescents: abnormal
amenorrhea together with bluish bulging hymen indicates imperforate hymen and indicates referral.
Additional subj. data for adult
postmenopausal bleeding warrants pelvic exam, transvaginal ultrasonography and referral.
Vaginal itching could indicate atrophic vaginitis
Pressure in genital area, loss of urine with cough or sneeze, back pain or constipation could indicate a weakened pelvic musculature and uterine prolapse.
Dev. Comp. Aging Adult - Objective
natural lubrication decreases
menopause and resulting decrease in estrogen cause numerous physical changes
pubic hair decreases
skin is thinner and fat deposits decrease.
Labia is flatter with hanging appearance.
clitoris size decreases after 60 y.o.
anti inflammatory is a good choice before exam to ease arthritis pain, as needed.
what is recommendation for cervical cancer screening
woman 65+ should stop cervical cancer screening if they have greater than or equal to 3 consecutive (-) pap tests or greater than or equal to 2 consecutive (-) HPV and pap tests w/in the last 10 yrs . woman w/ total hysterectomy should stop cervical cancer screenings.
