Gynaecology and womens health

Question 1

Urinary tract infection

Answer 1

• More common in women
• Self-limiting
• Increased frequency of passing urine, with urgency
• Burning pain when urinating
• Traces of blood in the urine
• Cloudy or malodorous urine
• Sensation of incomplete bladder emptying

Question 2

Danger symptoms of UTI

Answer 2

• Signs of upper urinary tract infection i.e. fever, back pain, vomiting, visible haematuria require urgent GP referral

Question 3

Treatment options for UTI

Answer 3

1. Alkalynizing agent - Potassium citrate, Sodium citrate and sodium bicarbonate
   - Avoid potassium products in hyperkalemia, renal or cardiac impairment as well as in patients taking potassium sparing diuretics, ARBs or ACEi
   - Sodium products are contraindicated in pregnant women or those with hypertension
2. Simple analgesics for pain

Question 4

Practical tips for UTI

Answer 4

• Drink required amounts of water
• Strain when urinating for 10-15 seconds after passing to expel residual urine
• Wipe from front to back to prevent contamination of the vagina
• Urinate after sexual intercourse
• Wear cotton underwear and avoid tight-fitting clothes
• Hot water bottle may relieve discomfort

Question 5

Vaginal thrush

Answer 5

• Vulval itching
• Local erythema (redness)
• Vaginal discharge which is white curd-like and odourless
• Pain in intercourse
• Pain during urination

Question 6

Danger symptoms of thrush

Answer 6

• First occurrence of symptoms requires referral to GP to diagnose
• Women over the age of 60 years
• Woman under the age of 16 years
• Pregnant women
• Diabetic patients
• Recurrent thrush

Question 7

Treatment options for thrush

Answer 7

• Topical imidazoles (clotrimazole, econazole and miconazole) via intravaginal pessary or cream
• Treat partner who is also symptomatic

Question 8

Practical tips for thrush

Answer 8

• Avoid tights or tight fitting trousers
• Wear loose, cotton underwear
• Avoid irritant or perfumed products

Question 9

Vaginal dryness

Answer 9

• Lack of estrogen causes thinning of vaginal walls
• Reduction in lubricating mucus
• Causes: menopause, smoking, hormonal contraceptive therapy, radiation therapy, chemotherapy
• Pain during sex
• Discomfort
• Itch
• Urinary problems

Question 10

Danger symptoms for vaginal dryness

Answer 10

• Patients with dry eyes, dry mouth and vagina dryness require referral to the GP

Question 11

Treatment options for vaginal dryness

Answer 11

• Lubricating creams i.e. to prevent pain during sex and lubricates the vagina for several hours
• Vaginal moisturisers i.e. Replens and Sylk

Question 12

Practical tips for vaginal dryness

Answer 12

• Avoid douching as this can lead to dryness and irritation
• Avoid perfumed soaps and bath products