Week 1: Women's Health (Lecture 1) Flashcards
Average life expectancy for women is
80 years old
causes of death are related to ___ & ___
age and race
What is the cause of death in 15-24 y/o’s?
Accidents & Violence
Cause of death in 25-44 y/os”s
- heart disease
- cancer
- suicide
- accidents
- violence
- HIV (6th 25-34), 5th (35-44)
Cause of death in 45-64 y/os?s
- heart disease
- cancer
- CVA
- COPD
- liver disease
- DM
- accidents
- suicide
- violence
Cause of death 65 & up?
- heart disease
- cancer
- CVA
4.COPD
5.pneumonia - accidents
Disease in White Women
- heart disease
- cva
- copd
4.all cancers except respiratory
5.pneumonia - flu
- accidents
- adverse events
- suicide
- hiv
Disease in Black women
- lung cancer
- liver cancer
- HIV (leading cause of death in women 25-34)
- homicide
- legal interventions
- DM
Teens
-Critical period in human development
-Complete physical growth and development changes
-Complete psychosocial development
-High risk behaviors
-In 2022, 16% of population 10-19
-14% of adolescents are pregnant before age 18
-51% of 12th grade students admit to sexual intercourse past three months
-Condom usage decreases by age
-Of the 30K + New HIV cases in the US, 51% were adults and adolescents in the south
Females begin puberty about 2 years earlier than males
Puberty is a response of the HPG axis
After puberty, the mature ovary takes over as the driving force of hormonal control in females.
Puberty
Rapid physical growth begins start of puberty; menarche is the end point
Spans 8-14 years of age
Duration 18 months to 5 years
Growth spurt between 8-17, with peak time at age 12
Average duration 3 years
Puberty
Females grow about 2 ½ to 5 inches and gain
8-20 pounds per year
Growth slows down after menarche
Weight gain is attributed to estrogen
Growth spurt precedes thelarche by 1 year
Thelarche and adrenarche are concurrent
Puberty
External and internal genitalia develop into adult female proportions
Menarche final landmark of puberty
Begins 1-3 years after thelarche and with tanner stage 3 or 4
Early on menarche is anovulatory
Cycle is set within 3-4 years
Development for teens 11-13
Peer acceptance and conformity important
Normal with peer group
Concrete thinking
^interest in sexual processes but no desire
Sexual fantasies are common- guilt
Expresses through dress, body language, and curiosity
Development for teens 14-16
Most turbulent
Egocentric but self-esteem in relation to peers
Rebellion and mood swings to independence
Abstract reasoning but also immortality
Sexual energy is high with emphasis on physical contact
Development for teens 17-21
Full sexual maturity
Development of a sense of self and purpose
Relationships are becoming monogamous and intimate
Abstract reasoning skills fully developed
Achieves sociological maturity
Teens Health Issues & Risks: Nutrition & Eating Disorders
Needs increase due to the metabolic demand
Need sources of PRO, CA, Zinc, Fe
Eating disorders are compulsive overeating, anorexia nervosa, and bulimia
Overeating results in obesity, 1 out of 10
Eating disorders frequently begin subsequent to a emotional trauma
Menstrual disorders
Abnormal bleeding- Acute adolescent menorrhagia. Usually results from anovulatory cycle. Can progress to life threatening hemorrhage
Menstrual disorders
Dysmenorrhea: most common complaints of adolescence. Usually associated with onset of ovulatory cycles.
Sexually Transmitted Diseases
HPV – most common
Chlamydia – 28%
Gonorrhea – 22%
HIV – 7% are 13 - 24
Sexually Transmitted Diseases
Among teens with HIV diagnosis – 81% are male and 19% female.
Most are sexually active by the time they ever see a health care provider.
Need counseling regarding safe sex
Act for youth.net
Teen Pregnancy
Pregnancy rate (15-19) 17.4 per 1,000 females in 2018
16.7 per 1,000 females in 2019
Abortion rate (15-19) In 2020, 5.5 per 1000
Birth rate (15-19) 24 births/1000
Majority are unintentional (82%), minority intentional
60% in live birth, 26% abortion, and 14% miscarriage (2010)
Adolescents are at increased risk for perinatal complications
Smoking
-6000 experiment and 3000 become smokers
-Don’t like it but want to fit in
-Know of risk factors but unconcerned
-Adolescent smoking has a negative correlation with academic achievement and a positive correlation with drugs and ETOH usage
Alcohol usage
-Still a problem but reached lowest levels in 2014
-35% reported one drink in the past thirty days (before survey)
-21% binge drinking
-Drunk driving has declined by 50% since 1991
2013 – 10% reported driving drunk and 22% rode with someone who was drunk (hss)
Caucasian – more likely to drive drunk
Act for youth.net
Illegal drug abuse
Substance free is increasing – 52% high school and 85% 8th graders were substance free 30 days.
Marijuana – most common. 23% past thirty days; 1% 8th graders are daily users – 6% 12th graders
Overall street drugs are declining but prescription drug abuse is increasing
Illegal drug abuse
Lifetime use - prescription drugs taken without a prescription (18%), inhalants (9%), hallucinogenics (7%), ecstasy/MDMA (7%), cocaine (6%), methamphetamine (3%), illegal steroids (3%), and heroin (2%)
Act for youth.net
___ is the 3rd cause of death after accidents in 15-24 year olds
suicide
___teens attempt suicide 4 times more than males
female
___ is associated with anger & depression
teen suicide
contributing factors for teen suicide?
-Divorce of parents.
-Violence in the home.
-Inability to find success at school.
-Feelings of worthlessness.
-Rejection by friends or peers.
-Substance abuse.
-Death of someone close to the teenager.
-The suicide of a friend or someone he or she “knows” online.
signs a teen may attempt suicide
Talks about death and/or suicide (maybe even with a joking manner).
Plans ways to kill him or herself.
Expresses worries that nobody cares about him or her.
Has attempted suicide in the past.
Dramatic changes in personality and behavior.
signs a teen may attempt suicide
Withdraws from interacting with friends and family.
Shows signs of depression.
Shows signs of a substance abuse problem.
Begins to act recklessly and engage in risk-taking behaviors.
signs a teen may attempt suicide
Begins to give away sentimental possessions.
Spends time online interacting with people who glamorize suicide and maybe even form suicide pacts
Cardiovascular disease
Atherosclerosis begins in childhood
Has a genetic and environmental factor
HTN in teens associated with obesity
Sexual Assault
50% rape victims are 10-19 and perpetrator is known
Can lead to self-blame and doubt
Longstanding effects on self-worth and identity
Care of a Teen
Health promotion – at schools or health fairs or in pediatrics office
Sexual behavior decisions – schools or during routine visits
Pelvic examination
Confidentiality and trust
Leading health risks of a teen
Cigarette smoking
Substance abuse
Medication overuse
sedentary life
Nutritional concerns
Unsafe driving
Violence
Blood borne disease
Leading health risks of a teen
Lack of personal care
Lack of sleep
Environmental
Stress
Family crisis
Poor/absent support
Mood disorders
Unrealistic value
Leading health risks of a teen
Lack of recreational activities
Poverty
Familial disease
Race
Ethnic, cultural, religious factors
How to know risk factors?
Communicate with the patient by:
Maintain professionalism
Client terminology
Open ended questions
Watch nonverbal cues
Let client to speak freely
Provide a private and quiet place
Have realistic time frame
Remain supportive, concerned, and nonjudgmental
Value honesty and encourage from client
special assessment guides
McMaster family assessment device
Family apgar
Nutritional assessment
Fitness assessment
Stress assessment
Sexual assessment
physical assessment
Generic exam components
Breast and Pelvic components
Pap smear
Bethesda System Nomenclature
Squamous cell abnormalities: ASCUS, LGSIL, HGSIL, Squamous cell cancer
Gland cell abnormalities: Endometrial cells, cytologically benign, AGCUS, Adenocarcinoma
Terms
CIN 1 (cervical intraepithelial neoplasia)
abnormal cells confined to lower third (mild dysplasia)
CIN 2
Extending into middle third (moderate dysplasia)
CIN 3
Into upper third (severe dysplasia)
CIS (carcinoma in situ)
full thickness involvement
Guidelines for pap smears
1st pap smear at age 21
Ages 21-29: every 3 years
Ages ≥ 30: every 3 years (pap only); pap plus HPV testing every 5 years
Guidelines for pap smears
May discontinue ages 65 if -
Negative history
3 negative paps in a row or 2 negative co-tests within 5 years
No need to screen after hysterectomy for benign diseases **
Pregnant women ≤ 20: no pap
ACOG guidelines 2017
Pap guidelines
Populations not appropriate to follow new guidelines
HIV positive
Immunosuppressed
Exposed to DES in-utero
Women previously treated for CIN 2, CIN 3, or cancer
Remain at risk for recurrent or persistence for 20 years (after surgery or treatment)
ACOG 2017
Pap
HPV testing
Not recommended for women under 30
HPV vaccine
Recommended for all women 11-24
Some physicians may get HPV testing with pap routinely.
Abnormal Initial ASC-US
If HPV negative – repeat pap in 12 months
If HPV positive – colposcopy
If after colposcopy
CIN negative – pap at 6 and 12 months or HPV testing at 12 months
CIN positive – manage according to cytology
LSIL
Colposcopy for all LSIL
If no lesion or no CIN
Repeat at 6 and 12 months, HPV 12 months
If lesion or + CIN
Biopsy and manage according to cytology
Usually either a LEEP or follow-up every 4 months
Pregnant non-teen
ASCUS or LSIL
Colposcopy preferred
Can defer initial until 6 weeks pp
No ECC
If no CIN 2, 3, or cancer – pp follow-up recommended
Postmenopausal LSIL
HPV testing
Colposcopy
Repeat pap smear at 6 and 12 months
HSIL
colposcopy for all HSIL
No lesion
Repeat at 4 or 6 months (6 or 12)
Lesion
LEEP
Repeat every 4 or 6 months (6 or 12)
HPV HR testing
Colposcopy with ECS (endocervical sampling)
Do HPV if not already done
Add endometrial sampling
If > 35 to all subcategories
IF < 35 with unexplained vaginal bleeding or chronic anovulation
Treat based on cytology
Natural history of CIN
CIN 2
43 % will regress
35 % will persist as CIN 2
22% will progress
CIN 3
32% will regress
52% will persist as CIN 3
14% will progress
women & sexuality
Women’s movement
Sexual beings
No guilt
Can enjoy sexuality
Sexual health defined as: WHO-State of physical, emotional, mental, and social well-being in relation to sexuality, not merely the absence of disease dysfunction or infirmity
women & sexuality
Sexuality-Unique human quality that reflects our need for closeness from others
Response is physical
Sexual desire-The urge for sex
Varies across life-span
Learned behavior
sexual response cycle
Excitement: vaginal lubrication
Plateau: vaginal engorgement and clitoral retraction
Orgasm: the peak of uterine vasocongestion and myotonia
Resolution: body returns to the pre-excitement phase
sexuality
Issues that affect sexuality for women include what?
How does she view herself as female
How does she present herself as female
Presentation of self as female: How does she behave in public?
Adolescence
Reproductive years
Midlife
Older adulthood
Disabled
Other orientation
sexual lifestyles
Heterosexual monogamous marriage
Serial heterosexual monogamy
Swingers
Living together
Single
Lesbianism/Bisexual
Celibacy
sexual concerns
Diabetics
Cancer survivors
Disabled
sexual myths
Women’s needs are second to men’s
Women take longer to become aroused
A women who initiates sex is immoral
Women must have an orgasm to like sex
Don’t discuss sex with your daughters
Older women have no sexual desire
Older women are sexually undesirable
Older women who enjoy sex are shameful
Interference with a positive view of sexuality
Loss of identity
Family influence
Relationship discord
Religious/cultural beliefs
sexual dysfunction
Definition: impaired, incomplete, or absent expression of normally recurring human sexual desire
Characteristics: physical-any phase
Categories: life-long or after trauma
sexual desire disorders
Hyposexual sexual desire -persistent absence or deficiency of sexual feelings, fantasies or desire for sex
Sexual Aversion disorder- extreme repulsion, loathing and avoidance of all genital sexual contact with a partner
sexual arousal disorders
Sexual arousal disorders- partial or total lack of physical response as evidenced by lack of vaginal lubrication and vasocongestion in the excitement phase.
sexual orgasm disorder
Inhibited female orgasm- persistent delay or absence of orgasm following a normal excitement phase during sexual activity.
sexual pain disorders
Dyspareunia- recurring genital pain before, during or after vaginal intercourse
Vaginismus- recurrent spasms of the outer 1/3 of the vagina which interferes or prevents coitus
sexual health care assessment
FNP must be aware of his/her sexuality
Components of sexual assessment
Do’s and don’ts
sexual health care assessment do’s
Find a private place
Confidentiality
Allow time for trust and rapport
Monitor your responses
Open ended questions
May use several interview sessions
Progress from simple to complex
Use client terminology
sexual health assessment donts
Act surprised
Demean the client
Laugh at a myth
Fidget because you are uncomfortable
What are the components of sexual history & assessment?
Physical
Psychological
Sociocultural
Sexual history
Separate form or part of complete history form
If part of complete form, keep brief and expand if needed
Sexual problem history
When to perform history and any lab?
Sample questions (see handout)
special women groups?
lesbiens, teens, disabled
Healthcare for lesbians
Be aware of bias
Remember barriers to care
Special barriers
Create a safe environment
Assess coping status
Common problems
STD’s
Cancer
Body image
Heart disease/stroke
Suicide
Mental health disorders
Violence
Teens healthcare
Body image
Views on sex and sexuality
Peer pressure
Not enough knowledge
Psychological issues
Self-concept
disabled women
Common concerns for all disabled women
Spinal cord injuries
Joint inflexibility/pain
Multiple sclerosis
Epilepsy
Urinary/bowel appliances
