S3 M1 Sexuality Flashcards
Having 1 STI increases the risk of having
Another STI
When a person has more than one STI or other medical problem, these sicknesses are labeled as
Concurrent
All STIs have a latent or subclinical phase which is -
having and being able to transmit the disease without symptoms
Viral STIs
Herpes
HPV
Hep B
HIV
Bacterial STIs
Chlamydia
Gonorrhea
Syphilis
Viral STIs are treated with
Vaccines
NO cure
treat symptoms
suppress virus
Bacterial STIs are treated with
Anti infectives
NO vaccines
Chain of infection
Pool/reservoir of infection Portal of exit Mode of transmission Portal of entry Susceptible host
Gonorrhea 101
Neisseira gonorrheae
Vag Anal Oral sex childbirth
Gonorrhea symptoms
Women
Men
Arthritis
Women
minor/overlooked symptoms
Endocervicitis (redness) Dyspareunia (pain with sex) purulent exudate dysuria frequency
Men Urethritis Dysuria (pain) Profuse purulent drainage Ball bag pain
Syphilis 101
phases
Treponema pallidum
Spirochete
vaginal anal oral childbirth
Primary - highly infectious
Secondary - infectious
Latent - noninfectious after 4 years
Late - noninfectious
Chlamydia 101
Chlamydia trachomatis
MOST COMMON STI
Vaginal anal oral or child birth transfer
Chlamydia symptoms
PID pelvic inflammatory disease most serious
painful urination
dysuria
infertility/sterility
Discharge Burning Dyspareunia Vaginal bleeding Lower ab and back pain
Anal sex - anal pain
Oral sex - sore throat
HPV 101
Human papillomavirus
Vaginal anal oral childbirth
Genital Warts
Vaccine available
Most common HPV types
Most carcinogenic HPV types
common - 6 and 11
carcinogenic - 16 and 18
Herpes HSV 101
Herpes simples
CAN be spread to infant at child birth
T1 - above waist, Cold sores
T2 - below waist
This isn’t always true
Virus enters nerve endings
Herpes HSV PRIMARY symptoms
Burning, Itching, Tingling
Lesions - rupture, crust, heal
last 17-20 days
Vesicles - infections
Pain fever headache malaise myalgia
Herpes HSV Recurrent episode symptoms
triggers - stress, fatigue, sunburn, illness, immunosuppression, menses
tingling burning itching before lesions
lesions last 8 to 12 days
Herpes none medical treatment
Hygiene
Cotton undies
Clean/dry lesions
Start STI treatment of antibiotics __ culture
before
STI Treatment teaching
Finish antibiotics
Let partners know
Abstain during treatment
Follow up examination and culture
Primary STI prevention
Safe sexual contacts
No IV drug use
Be vaccinated
Use a condom
Secondary STI prevention
Seek care immediately
Follow treatment regiment
Disclose partners/contacts
Tertiary STI prevention
Prevent reinfection
If virus - maintain healthiest condition possible
diet, sleep, education, drug therapy etc.
Organic ED
Related to Diabetes HTN Decreased hormone production Med side effects
Functional ED
Stress
Performance anxiety
ID personal issues like anger anxiety depression
Differentiate between Organic and Functional ED by
Assessment for ED
Onset
Organic gradual
Functional acute
International Index of Erectile Function
If ejaculation of tactile sensation is absent before treatment
it can not be restored
ED treatment
PDES inhibitors
NOT with nitrates = severe hypotension
Invasive ED treatment
Intraurethrals - gels injections or pellets to go in
Vaso constrictive device - dick pump with ring
Implant - Can result in mechanical failure, infection, erosion
Gender dysphoria
Cross-gender identification
Persistent desire to be of other sex
Persistent discomfort in own sex
Gender identity is based on
Sexual identity
AND
Internal experience
If those don’t match then the person is transgender (differently gendered)
Transsexual
ID with opposite gender
Preop transsexual
Altered physical appearance
Intersexed
Born with ambiguous sexual organs
Cross-dresser/transvestite
Wears clothing of the opposite gender
Gender dysphoria criteria
Difference in gender identity lasting longer than 6 months
For gender dysphoria to be diagnosed in kids the desire must be
Present AND verbalized
Dyspareunia
Pain before during and after intercourse
burning stinging sharpness extreme tenderness sensation
Dyspareunia causes
Physiological pelvic disorder sti endometriosis menopause
Psychological
abuse stress depression
Treatment for altered libido
Medication
Counseling
Hormones
Lifestyle remedies
Causes of altered libido
Physical
Hormonal
Psychological
Relationship issues
Dyspareunia (Menopause)
Treatment
Hormone therapy
Calcium Vit D
SERMs
Managing Dyspareunia pain with sex
Vagifem tabs
Premarin cream
Moisturizers
Lubricants
Candidiasis treatment
Miconazole
Clotrimazole
Terconazole
Fluconazole
Treatment for Chlamydia
Doxycycline 100mg bid x7days
Azithromycin 1g x1
Erythromycin 500mg qid x7days
Abstain from sex for 7 days post 1st pill
retest in 3 months
Gonorrhea treatment
Azithromycin 1G x1 AND
Ceftriaxone 250mg IM x1
abstinence for 7 days
test 3 months
P
LI
SS
IT
P permission - allow to talk
LI limited information - give all the info
SS specific suggestions - advise lifestyle changes
IT intensive therapy - referral for more involved treatment prn
Herpes treatment
1st episode - antivirals
Acyclovir 400 tid 7-10 days
Acyclovir 200 fiveID 7-10 days
Famciclovir 250 tid 7-10 days
Valacyclovir 1G bid 7-10 days
if unresolved extend past 10 days
Diagnosing HSV
Viral culture
NEVER papsmear
Syphilis treatment
Benzathine Penicillin G 2.4million units IM
Primary and secondary
Benzathine penicillin G 2.4million units IM Q week for 3 weeks
Late stage
use doxy tetra or arithro if allergic to PCN
1st stage of syphilis symptoms
painless chancre at sight of infection
lasts 1 to 6 weeks
2nd stage of syphilis symptoms
appears 2 to 6 months after 1st
flulike symptoms
rash on soles palms and trunk
alopecia
lasts 2 years
3rd stage of syphilis
lasts 20 years
Destroys heart brain skin and CNS
Tests for syphilis
VDRL venereal disease research lab
RPR rapid plasma reagin
FTA-ABS fluorescent treponemal antibody absorbed
TP-PA T pallidum particle agglutination
Best position for PID
Semifowlers
HPV diagnosing
Visual inspection
Pap smear
+ HPV test
HPV treatment
Imiquimod cream
Podophillin solution
Trichloracetic acid
Freeze
Burn
Laser
Surgical excision
2 vaccines for ages 11 to 15
3 vaccines for older folk
CD4 T normal
CD4 T with aids
450-1200
bellow 200
HIV screening test
Nucleic Acid Test NAT
Antigen/antibody test
Antibody test
HIV treatment
ART Antiretroviral therapy
HIV Prophylaxes med
PrEP
Diagnosing infertility
Diagnosed after 1 year of trying
Secondary infertility
Inability to conceive after a previous pregnancy
Infertility is now considered a _
as opposed to _
Disease
Disorder of inconvenience
Uterine fibroids
Benign tumors that prevent pregnancy
At what female age is it difficult to conceive
27
Endometriosis
Uterus lining grows outside of uterus
More severe pain during cycle
Causes infertilities
Normal sperm
Greater than 20 million per ml
50% are motile
If sperm count normal go see a
Urologist
Assessment of female pregnancy potential
Ovulation predictor kit
LH level
Pap smear
to visualize
Ultrasound
Hysterosalpingography
Laparoscopy
Management of infertility for women
Clomid - oral
Pergonal - injection
IVF in vitro fertilization
GIFT gamete intrafallopian transfer
Surgery
Surrogate
With infertility nurses should know the drugs
benefits and side effects
Some fertility drugs may result in
Multiple births
Provide medical-legal surrogacy information regarding
true ownership
Biggest cause of infertility in women
Endometriosis
Behavioral contraception types
Abstinence
Fertile awareness (skip ovulation days)
Withdrawal (pullout)
Lactation amenorrhea (no ovulation)
Spinnbarkit Mucous
slippery clear mucous that facilitates passage of the sperm through it
Barrier contraception
Condom
Diaphragm
Cervical cap
Sponge
Store condoms in a
buy condoms with
Cool dry environment
Spermicide
_ based products can brake condoms
Oil
Female condom can be inserted for up to
how to insert
8 H before intercourse
inner ring against cervix
outer rink outside of vagina
Diaphragm contraception
NO OIL
Can be placed up to 6h before MUST remain for AT LEAST 6h after
If you lose are gain 10lb you need a new measurement, or after 2 years
Never leave it in for more than 24h
Cervical cap contraception
Put spermicide in the cap NOT on edges
Need to place at LEAST 30 min before
Leave in for 6H after
Can be left in place for 48H
replace after 2 years
Leaving a diaphragm cervical cap or sponge in for more than the recommended time can cause
Toxic shock syndrome
Contraceptive sponge
NO prescription needed
Wet it and place in
will release spermicide for 24H
leave in for 6h after intercourse
can be used multiple times
Don’t leave in for more than 30h
toxic shock syndrome
Toxic shock syndrome
Overgrowth of Staph Aureus and its toxins
Sudden, Potentially fatal,
SHARP drop in BP, Shock, Organ failure due to lack of flow.
Contraceptioin
Family planning
Birth control
intentional prevention of pregnancy
lifespan of ovum _
ovum is released…
lifespan of sperm in utero _
So fertility period is…
24h
14 days before next cycle
5 days
6 days 3 before and 3 after ovulation
Cervical mucus ovulation method
When mucus becomes spinnbarkeit
slippery, smooth, clear, abundant
BBT
Basal body temp
Progesterone elevates temp 2 days after ovulation
Standard days method
Avoid sex between day 8 and 19
Only if cycle is between 26 and 32 days long
Depo Provera
PROGESTERONE only
12 week intramuscular injectable contraceptive by reducing FSH and LH production
Cycle may not be restored for up to 9 months
Loss of bone marrow density, acne weight gain, depression
Transdermal patch
1 a week except bleeding week
risk of thrombosis and embolism
Patch will burn during MRI
Rotate patch area
Vaginal ring
NuvaRing
insert for 3 weeks
take out for bleeding week
LARCs
Long-acting reversible contraceptives
Implant
Nexplanon
subdermal, good for 3 years
headaches, weight gain, acne, appetite increase, breast tenderness, depression
IUC
Intrauterine
Contraceptive
endometrium becomes hostile to fertilized ovum
lightens periods
Sterilization
surgical procedure rendering person infertile
Laparoscopy for females
Vasectomy for men
Tubal ligation
Laparoscopy or minilaparotomie
Fallopian tubes are cauterized clipped cut or tied
Essure
Tiny coil is placed in fallopian tubes
coil promotes tissue growth blocking off the canals
COMPLETELY irreversible
BAD not on market any more
Vasectomy
Cutting of the vas deferens from under scrotum.
Religions problematic with fam planning and abortion
Roman Catholic anti
Islam only for serious reasons
Judaism only first trimester
Nursing interventions with contraception
Encourage educated choice Obtain written consent Discuss contraindications Consider religion and culture Address myths
Abortion
expulsion of embryo or fetus before it is viable
Medical abortion
Mifepristone or Misoprostol
Empties uterus via cramping and bleeding
Surgical abortion
Vacuum or dilation and evacuation D&C
Before giving semen sample, abstain for
deliver it to the lab within
2 to 5 days
1h
Azoospermia
Oligospermia
Asthenospermia
Absence
Decrease
Poor motility
DOR
Diminished ovarian reserve
higher rate of miscarriage
Assisted reproductive technology ART
IVF in vitro fertilization daily FSH and LH injections removal of oocytes incubation with sperm for 5 days injection via cath into female
Monophase
Biphase
Triphase
birthcontrols
Same level of estrogen and progesterone
2 different levels
3 different levels
Mini pills vs regular birth control pills vs extended pills
Mini pills have to be taken same time every day
Regular birth control more forgiving
have a cycle 4 times to once a year
Benefits of birth control
acne hirsutism endometriosis pms dysmenorrhea decreases bleeding
disadvantages of birth control
MI stroke hypertension Venous thrombosis Pulmonary emboli Boob cancer
No combination pills for women over
35
take mini pill
Antibiotics + birthcontrol =
decreased effect of birth control
Use back up method for AT LEAST 2 weeks
ACHES of OC oral contraceptives
A - abdominal pain, liver/gallbladder C - chest pain, SOB P/embolism H - headaches, HTN, stroke E - eye problems, HTN S - Severe leg pain, thromboembolism
Embolisms with OC oral contraceptives are caused by which hormone
Estrogen
Depo provera
Biggest side effects
use over 2 years is associated with
Menstrual cycle disturbances
bone loss
increase calcium and vit D
Transderm patches are not for women over
198lb
Mirena and Skyla
intrauterine contraceptives
progesterone only
Mirena good for 5 years
Skyla good for 3 years
ParaGard does NOT have hormone
copper only
IUD complications
PAINS
P - period late, pregnancy, spotting A - abdominal pain, with intercourse I - infection, vaginal discharge N - not feeling well, fever, chills S - string length, shorter/longer/missing
Abortion pills can be used up too _ days after last menstrual period
70 days
9 weeks
Abortion pills need a _ to be given
prescription
Next choice vs plan b
Next choice 2 pills 12h apart
plan b 1 pill
take within 72h
IUD can be used as an
what emergency contraceptive can be take for up to 5 days
emergency contraceptive for up to 7 days
Ella
Highest side effects of emergency contraceptives
Nausea and Vomiting
Breast tenderness
dizziness, fatigue, headaches
Worst case emergency contraceptives can lead to
Egtopic pregnancy
fetus in felopean tube
Chlamydia diagnosing
Culture
NAAT nucleic acid amplification and testing
Conjunctival secretions in neonates
Chlamydia and gonorrhea has to be reported to
CDC health department
Chlamydia in neonates
Conjunctivitis
Pneumonia
low weight
preterm birth
Gonorrhea diagnostics
culture
NAAT
Chlamydia and gonorrhea should be tested for
ever year for patients under 25 per CDC
Gonorrhea in newborns
Gonococcal ophthalmia
arthritis
urethritis
miscarriage
Herpes diagnostics
Visual
culture swab
Polymerase chain
Serologic test
Candyloma lata
syphilis rash does not
sign of syphilis
itch
Can you reverse Tertiary late stage syphilis
NO
Birth with syphilis
deformed bones anemia liver spleen issues jaundice meningitis
Number 1 cause of cervical cancer
HPV
Trichomoniasis 101
Trichomonas vaginalis
Trichomoniasis diagnosing
NAAT
Microscopic evaluation
Trichomoniasis treatment
Metronidazole 2G PO x1
Tinidazole 2G PO x1
Metronidazole 500mg PO bid 7 days
Trichomoniasis symptoms
Dysuria Frequency Frothy discharge Dyspareunia Itching
Strawberry cervix
Menopause
Decrease in estrogen
dryness
vaginal atrophy
pH increase
If menopause patient still has uterus, MUST give
Progesterone with estrogen supplement
or increased risk of hyperplasia and endometriosis
Menopause treatment
Give LOWEST dose possible for SHORTEST amount of time possible
E-string
Estrogen vag tabs
Premarin cream
Testosterone patches
Sex with menopause
Communicate with partner
Foreplay
Intimacy w/o penetration
Sex counseling
A decline in sexual activity _ _ mean decline in desire
DOES NOT
Decrease in sexual desire for men and women
Men - decrease in T, poor health, meds leading to ED
Women - decrease in estrogen, loss of partner
Both - take longer to arouse, longer to complete and longer to occur again
more than half of men between 40 and 70 have
ED
how erections work
Smooth muscle RELAXATION
Blood fills
ED diagnostics
physical assessment
Nocturnal penile tumescence test
3-5 erections lasting 10-15 min each is normal
Arterial blood flow doppler probe
nerve conduction test
psych eval
Dick pill side effects
headache flushing dyspepsia diarrhea nasal congestion
dyspepsia
stomach pain
Dick pills are contraindicated in folk who take
or have
only use
Nitrates (isordil, nitroglycerin) hypotension
bad bp, live, kidneys, heart
once a day
Alprastadil inj
once a day
Smooth muscle relaxant injection
for erections, 20 min before intercourse
pain, plaque, priapism
Alprastadil supp
Can be used up to twice a day
injected into urethra
massage dick to dissolve
10 min before intercourse
Dick pump bands can not be left for more than
1 hour
Only use dick vacuum pump that has a
limiter
Semirigid rod
Inflatable devise
Inserted into corpus cavernosum of dick
will not be able to do cystoscopic surgery to view bladder
may cause infection
erosion of prostate
Inflatable dick implant
Pump reservour in abdomen to directed water to dick and back
Gender nonconformity is _ the same as gender dysphoria
NOT
Most common complaint of gender dysphoria
social isolation
Hormones used during transitioning
Androgens
Antiandrogens
Estrogen
Testosterone
4 categories of birth control
Behavioral
Hormonal
Barrier
Permanent
Danger signs of hormonal contraceptives
ACHES
Which IUD does not use hormones
Copper
great for folks who smoke, cant take hormones, etc.
Once syphilis is cured will the patient still test positive
YES
Latent phase of syphilis
Syphilis S/S
Rash on palms and soles
Vaginal discharge
Painless blister-CHANCHER SORE
Classic symptom of chlamydia for both men and women
Dysuria
painful urination
