Minor Ailments - Women's health Flashcards
1
Q
How to question for women’s health?
A
- Approach sensitively=personal topic for women
- Offer a confidential space
- Establish rapport
- Thorough questioning, accurate history = May have to ask sensitive quetsions, durations & other symptoms
- Sexual history – sexually transmitted infections
(STIs) i.e How many partners, married, who partner is(gender) , age of partner(potential for abuse), Abortions, given birth
2
Q
What is Bacterial vaginosis (BV)?
A
- Overgrowth of anaerobic bacteria (gardnerella vaginalis) and loss of lactobacilli in the vagina, pH increases to over 4.5
- Approx 50% of women with BV are asymptomatic
- Most common cause of abnormal vaginal discharge in women of child bearing age
- BV not sexually transmitted but more common in sexually active women, considered ‘sexually associated’
- Women with BV are at increased risk of STIs
- Vaginal swab & test pH to diagnise though this can not be done in the community
3
Q
What are the symptoms of BV?
A
- Strong fishy smelling vaginal discharge
- Discharge -grey/white colour, thin/watery consistency
- Usually no vaginal soreness, itching or irritation
4
Q
What causes of BV?
A
-Use of vaginal washes, douches= washes away protective lining for the vagina
- Being sexually active
- Concurrent STI
- Menstruation
- Smoking
- Copper intrauterine device = contraceptive device
5
Q
How to manage BV?
A
- Asymptomatic ( no symptoms) – do not treat
- OTC products- lactic acid based, restore normal pH
- 1st line – Oral metronidazole (POM) 400mg twice a day for
5-7 days (or single dose of 2g) - 2nd line – Intravaginal metronidazole gel (POM) or
clindamycin cream (POM) - 2nd line = if 1st line dosen’t work or red flag s= refer to GP for prescription
6
Q
What is candida or thrush?
A
- Thrush, Genital thrush, Vulvovaginal candidiasis
- Inflammation of the vagina and/or vulva caused by a fungal infection, usually candida albicans
- Up to 20% of women have candida part of normal
flora, overgrowth causes infection and symptoms - More common in women of child bearing age
- Very common, over diagnosed
- Approx 75% of women will experience candida once
- Recurrent infection - 4 or more episodes in 1 year
- Cold be an undelrying cause = i.e diabets= hgih blood glucose = good enviorment for thrush
7
Q
What are the symptoms of candida/ thrush?
A
- White discharge (usually no odour)
- Vaginal itching and irritation
- Dysuria = pain passing urine
- Pain during sexual intercourse
- Dysturia can also be symptoms of other thigs i.e STI’s so do they have other symptoms
8
Q
What cause candida/ thrush?
A
- Recent antibiotic use
- Local irritants: soaps, shampoo, shower gels
- Pregnancy
- Uncontrolled diabetes = good environment for thrush
- Immunocompromised
- Combined oral contraceptive pill = additional oestrogen
9
Q
How to manage candida/ thrush?
A
- 1st line -Fluconazole 150mg capsule (P) one dose OR
clotrimazole 500mg pessary (P) one at night equally effective,
clotrimazole gives more rapid relief
AZOLE = drug class - Pessaries work faster
- External itching – also offer clotrimazole 2% cream (P)
- Personal preference
- Drug interactions = Azoles interact w/ many med i.e carbamazepine = increase conc of carbemazeibine & decreases effect
- Treat partner if symptomatic = can be passed onto partner via sex
10
Q
How to adminster pessaries?
A
- Wash hands
- Remove the pessary from packaging, place into
applicator. Applicators are not always supplied - Lie on back with knees drawn towards chest,
insert applicator deeply in vagina as comfortable - Slowly press plunger of applicator until stops,
remove and dispose of applicator - Remain in supine position
- Can use lube to help w/ ease of insertion
- Insert via narrow end
11
Q
Prevent thrush via self care
A
- Avoid irritants: fragranced soaps, shower gels, bubble bath, shampoo
- Avoid tight clothing – underwear, jeans
- Thrush thrives in warm environments
12
Q
when to refer candida/thrush?
A
- Women under 16 or over 60 years = unlikley to be thrush as there is less oestrogen
- Recurrent infections
- Failed treatment= Thrush is resistant or wrong diagnosis
- Systemically unwell – fever
- Pelvic inflammatory disease (PID) – abdominal pain,
pain during intercourse, abnormal vaginal bleeding = Infection of female reporductive system - History of STIs = Can get overlap of symptoms
- Pregnant women
- Diabetic patients = likely that diabets = uncorntrolled & needs to be managed
13
Q
Testing for candida/thrush = Home test kits
A
- can be brought OTC
- Differentiate between thrush and BV
- Self test, vaginal swab, results in 10 seconds
- Based on vaginal pH and symptoms
- Back of box/ container guides you through the reuslts
14
Q
What other proudcts are availble for candida /thrush?
A
- Cleansing washes, wipes (GSL)
- Probiotics for vaginal use (GSL) = restores normal flore = not much evidence to support
- Local anaesthetic cream e.g. Vagisil (lidocaine)
(GSL) = helps w/ vaginal itching = numbs the area i.e vagisil
15
Q
What is Cystitis?
A
- Lower urinary tract infection
- Inflammation of urethra and bladder
- Bacteria from the GI tract, usually E.coli
- More common in women as shorter urethra
- Usually affects 15 – 34 years old’s = women of childbearing age
- 20 to 50% of all women experience at least once
- Not so common in men = refer men
