Week 9 Reproductive System Flashcards
The importance of reproductive health includes sexual education, prevention of STIs, early detection and management of reproductive disorders and family planning. Developing a deeper understanding of reproductive health is multifactorial and requires comprehensive knowledge of the differing components affecting men, women, non-binary and gender diverse people. This week we will explore many of these facets that contribute to reproductive health.
Sexual and reproductive health (SRH) refers
to a person’s right to a healthy body; encompassing complete physical, mental, and social well-being related to the reproductive system, and it’s functions and processes.
It includes the ability to freely decide when and how to have a safe and satisfying sex life, the capacity and freedom to have a child, the autonomy to make informed choices and the ability to have a healthy pregnancy.
SRH also relates to the knowledge and access to healthcare products to avoid sexually transmitted infections (STIs). SRH is an integral part of overall health and well-being, ensuring our population is free from discrimination, free of coercion and free from health risks.
The female reproductive system is broken down into primary and secondary organs.
The primary organs are the ovaries
Secondary organs include the uterus, fallopian tubes, the vagina, Bartholin’s gland, the breasts and the external genitalia.
Those that were assigned female at birth, women who have transitioned to a man and non-binary people can also have, or have had, female reproductive organs and be impacted by disorders related to this body system.
There are 3 primary roles of the female reproductive system:
Production of eggs (ova)
Secretion of hormones
Protection and facilitation of the development of a foetus
Dysmenorrhea
Dysmenorrhoea is pain or discomfort associated with menstruation. More than 50% of women who menstruate will experience dysmenorrhoea for 1-2 days every month. Often, the pain is reported as being mild and manageable in nature. For many others, the pain associated with menstruation is severe and debilitating, impacting lifestyle by preventing typical activity.
Clinical Manifestations
Dysmenorrhea
Can be associated with:
Nausea & vomiting
Headaches
Fatigue
Dizziness
Diarrhoea
There are 2 types of dysmenorrhoea:
Primary Dysmenorrhoea
Secondary Dysmenorrhoea
Primary Dysmenorrhoea
Cramping, abdominal pain that can radiate to lower back and thighs
Occurs prior to the onset of menses or after bleeding has commenced from elevated prostaglandins levels → causes uterine muscles and blood vessels to contract
Pain can last 12-48 hours → prostaglandin levels decrease once the uterine lining starts to shed → pain will then start decreasing
Usually commences with menarche and becomes less intense with advancing age
Also associated with headaches, nausea, vomiting diarrhoea, fatigue, and breast tenderness.
Secondary Dysmenorrhoea
Caused by disorders of the reproductive organs
Onset of pain and associated clinical manifestations usually a few days prior to menstruation and will intensify over the duration of the period → pain may not resolve by the time menstruation has ceased
Clinical manifestations will be related to the identified disease.
Disorders responsible for secondary dysmenorrhoea endometriosis, uterine fibroids, adenomyosis, defects of the reproductive organs, Crohn’s disease, urinary disorders
Dysmenorrhea
Treatment
Pharmacological management → NSAIDs and paracetamol → NSAIDs reduce prostaglandins → decrease cramping
Non-pharmacological management → acupuncture, acupressure, heat packs, nerve stimulation therapies
Dysfunctional Uterine Bleeding
Defined as painless, excessively heavy, prolonged, or frequent bleeding of the uterus that is not due to typical menstrual patterns, pregnancy, or a systemic disorder. Dysfunctional uterine bleeding (DUB) is one of the most common reasons for a woman to be referred to a gynaecologist for further investigation and management.
Can occur at any age but more likely with menarche or during perimenopause.
Usually not a symptom of a serious underlying condition
Disorders that can lead to DUB → uterine fibroids, adenomyosis, endometriosis, cancer, pelvic inflammatory disease, intrauterine device implantation, inflammation of the cervix
Some medications can result in DUB → OCP, antiplatelets, anticoagulants
Dysfunctional Uterine Bleeding
Clinical Manifestations
Typically associated with:
Fatigue
Anaemia
Dizziness
Headaches
Nausea
Vaginal discharge
Bowel and urinary symptoms
Can lead to menstrual changes → irregular cycles, bleeding post menopause, amenorrhoea, prolonged bleeding, spotting
Dysfunctional Uterine Bleeding
The types of DUB include:
Types
Amenorrhoea → absence of menstruation
Oligomenorrhoea → scant or irregular menses
Menorrhagia → excessive or prolonged bleeding
Metrorrhagia → bleeding between menstrual periods
Polycystic ovarian syndrome (PCOS)
Although poorly understood with no clear aetiology, PCOS is considered one of the most common hormonal disorders that affects 1:10 women of reproductive age. Most women are diagnosed between 20-30 years, when they are attempting to get pregnant but are experiencing difficulties conceiving.
Imbalance of reproductive hormones → excessive androgen production triggered by inappropriate secretion of gonadotropin
Prevents ovulation → causing enlarged ovaries, cyst formation on the ovaries and excessive endometrial proliferation
Polycystic ovarian syndrome (PCOS)
Clinical Manifestations
Associated with a range of clinical manifestations that vary between women, including:
Anovulation
Elevated testosterone
DUB → amenorrhoea, oligomenorrhoea
Persistent acne
Hirsutism → excessive female hair growth in areas where hair growth is usually minimal
Male pattern baldness
Darkening of the skin → along neck creases, groin and underneath the breasts
Infertility
Excessive amount of skin tags
Obesity
Additionally, women can experience numerous long-term, cardio-metabolic issues, including:
Hyperinsulinaemia key role in androgen excess and anovulation
Hyperandrogenemia → increases risk of glucose intolerance and diabetes → both type 2 and gestational
Dyslipidaemia
Systematic inflammation
Non-alcoholic fatty liver disease
Cardiovascular disease → hypertension
Coagulation disorders
T2D & glucose intolerance
Polycystic ovarian syndrome (PCOS)
Diagnostic Criteria
Menstrual irregularity
Clinical hyperandrogenism
Ultrasound confirmation of polycystic ovaries
Polycystic ovarian syndrome (PCOS)
Treatment
Hormonal contraception → suppresses androgen production and decreases endometrial hyperplasia
Insulin sensitisers → metformin → increases fertility and decreases risk of T2D
Endometriosis
A condition that occurs when endometrial cells implant outside of the pelvic cavity through retrograde menstruation. Each of these endometrial implantations respond to hormonal changes, breaking down and bleeding with each menstrual cycle, causing inflammation and pain to surrounding structures.
1:9 women of reproductive age (50% of infertile women) are affected
Inflammation can lead to fibroids, benign tumours, scarring and adhesions
Mostly affects reproductive organs and surrounding structures → endometrial cells can be picked up and transported through the vascular system → can implant on any surface anywhere in the body → rectum, bowel, bladder, brain, ligaments, skin, joints, lungs, and liver
Endometriosis can be very debilitating with significant physical, emotional, financial, and psychosocial impacts, including severe pain, depression, anxiety, and social isolation
Symptoms often improve after menopause
Endometriosis
Risk factors
Early menarche
Shortened menstruation → cycle <27 days
Menorrhagia
Increased menstrual pain
Family history of endometriosis
Delayed childbearing
Endometriosis
Clinical Manifestations
The clinical manifestations of endometriosis vary in frequency and intensity:
Heavy, throbbing pelvic pain → radiation can occur down the thighs and around to her back
Feeling of heaviness and discomfort in the rectum when having a bowel movement.
Dyspareunia
DUB
Dysmenorrhoea
Infertility
Dyschezia → pain with defaecation → occurs with bleeding from endometrial implantation on the rectosigmoid musculature and subsequent fibroids
Constipation
Endometriosis
Diagnosis
Aim is for improved awareness, earlier diagnosis, and patient-focused care in primary settings
On average, it takes 6.5 years for diagnosis, as per Endometriosis Australia
Diagnostic delay due to barriers:
→ Difficulty establishing disorder symptoms from normal menstruation → symptoms fluctuation and are varied in severity some → symptoms mimic other disorders such as irritable bowel syndrome
→ Normalisation of menstrual pain → women delay seeking review as they believe their symptoms are ‘normal’ and ‘to be expected’
→ Use of self-care techniques to manage symptoms
→ Menstrual stigma → medical professional may dismiss symptoms or attribute symptoms to a psychological disorder
→ Some women can be asymptomatic and only become aware of diagnosis when being investigated for infertility
→ Lack of education for healthcare team
Only diagnostic available to confirm endometriosis is laparoscopic surgery with biopsy, under general anaesthetic
Endometriosis treatment
There is no cure for endometriosis → focus on symptom management
Hormone treatment → oral contraceptive pill (OCP), or intrauterine device (IUD)
Surgery for severe cases → hysteroscopy, laparoscopy, hysterectomy
Analgesic
TENS machine
Complementary and alternative medicine
Endometriosis
Nursing Management
When caring for a woman with reproductive health disorders, nurses play a pivital role in ensuring person-centered care is delivered. As reproductive health disorders can result in devastating physical, emotional and psychosocial issues, women not only require their gynaecological problems addressed, but also their unique needs, preferences, and concerns. Nurses can provide empathetic support, actively listen and tailor plans accordingly.
Establish a rapport and communicate openly, using clear language and active listening skills → essential for you to develop a trusting, therapeutic relationship and to be able to obtain a good health history
Empowerment → by involving women in decision-making, nurses empower them to actively participate in their own health management. This collaborative approach ensures that treatments align with the woman’s values, lifestyle, and goals.
Create a safe space → some reproductive health disorders, such as PCOS or endometriosis, carry social stigma. Nurses can create a safe space where women feel comfortable discussing their experiences without judgment. This fosters trust and encourages women to seek timely care.
Education → Discuss ways to minimise clinical manifestations such as weight gain, coping with stress and impact on lifestyle
Pharmacological management → including oral contraceptives and analgesia
Non-pharmacological management → applying heat to the lower abdomen or back and physical exercise.
Reassurance & support → includes psychological support → link to support groups or specialised nurses
Encourage regular follow-up with GP / Specialist
Nursing care of the woman who has had gynaecological surgery
Preoperative Considerations
Preoperative checklists and assessments as per facility procedure.
Pregnancy test
Education
Support
Postoperative Considerations
Observations should include assessments for signs of bleeding and infection.
Bladder function should also be monitored.
Wound care and assessment.
Spontaneous Abortion
Spontaneous abortion is the medical term that relates to miscarriage.
Occurs in approximately 1:4 pregnancies in Australia
Defined as the loss of a pregnancy that occurs before 20 weeks gestation
→ 30% of pregnancy loss occurs between implantation and 6/40 (6th week gestation)
Women not only experience the physical effects of miscarriage but also psychological morbidity.
→ Feelings of grief and loss not only for the physical loss of their baby but also for the hopes and dreams that come with having a child
→ For some women, the feeling of loss and grief can lead to depression, anxiety and post-traumatic stress disorder that can require intensive psychological care
Threatened Abortion
→ unexplained vaginal bleeding in the first trimester of pregnancy
→ also called threatened early pregnancy loss
→ often associated with pelvic cramping with no cervical dilatation
→ may result in complete or incomplete abortion or the pregnancy may continue without any further concerns.
Spontaneous Abortion
→ all products of conception are spontaneously expelled within the first 20 weeks of gestation
→ also called complete abortion
→ physically and emotionally painful
→ associated with heavy vaginal bleeding, severe cramping, vaginal loss of fluid and tissues, moderate to severe pain to pelvis and lower back
Incomplete Abortion
→ same as for spontaneous abortion but with only partial expulsion of the products of conception (usually the foetus)
→ it is important to note that the term incomplete can be confusing for women and therefore providing false hope should not be encouraged.
Inevitable Abortion
→ A threatened abortion becomes an inevitable miscarriage when cervical dilation starts to occur, and the products of conception are expelled.
Septic Abortion
→ gynaecological emergency
→ severe uterine infection that occurs just prior to, immediately after, a spontaneous abortion.
Missed Abortion
→ occurs when a pregnancy stops developing and the products of conception remain in the uterus
→ also referred to as an early pregnancy failure
→ surgery is required to remove the products of conception
→ common clinical manifestations include pelvic pain and cramping, or the patient will be asymptomatic
Recurrent Abortion
→ a history of three or more abortions
Nursing Management
When caring for a woman experiencing a miscarriage, nurses play a vital role in providing both physical and emotional support.
Identification of associated clinical manifestations → you need to be vigilant in your assessments and health history to be able to promptly identify the clinical manifestations of a spontaneous abortion, such as vaginal bleeding, pelvic pain, and the passage of tissue. Prompt recognition allows for timely intervention and emotional support.
Emotional Support → miscarriages can be emotionally distressing for the woman and their partner / family. You must develop empathetic and compassionate skills to address their feelings of grief, loss, and sadness. Providing a safe space for the patient and their family / support, to express their emotions is crucial.
Physical assessments → Monitoring and assessing the patient’s physical health is essential. This includes assessing vital signs, managing bleeding, and identifying any signs of complications. Collaboration with the interprofessional team ensures appropriate interventions are implemented.
Grief Support and Coping → You can equip your patients and their families with resources for grief counselling and support groups. Facilitating coping mechanisms helps the patient and their family to navigate the emotional aftermath of a miscarriage. Consider the interprofessional team and who you can refer to → specialised nurses, social worker, grief counsellors.
Ectopic Pregnancy
An ectopic pregnancy occurs when an embryo is growing in the wrong area by implanting outside of the uterus → usually in the fallopian tube.
Typically, for conception to occur, the ova and sperm will meet in the fallopian tube. Once fertilised, the egg continues its journey into the uterus where it will attach to the wall of the uterus which will trigger the placenta to form. Once the placenta starts to grow, human chorionic gonadotropin will start to be released in urine and blood. With an ectopic pregnancy, the fertilised egg stays and implants in the fallopian tube.
The uterus can stretch and grow with a pregnancy. However, the fallopian tube cannot expand in the same way. Ultimately, an ectopic pregnancy cannot continue to develop. The stretching of the fallopian tube that occurs when the pregnancy progresses, results in severe pain and, if the tube tears or ruptures, vaginal bleeding → most ectopic pregnancies rupture between 6-16 weeks
→ 2:100 pregnancies will be ectopic
→ In 95% of cases, the most common site of implantation are the fallopian tubes → occurs due to an obstruction such as adhesions from previous infections, congenital malformations, scars from tubal surgery or tumours
An ectopic pregnancy is a gynaecological emergency and, if left untreated, can result in maternal death. This is due to the significant internal bleeding that often occurs.
Ectopic Pregnancy
Risk
Increased risk of an ectopic pregnancy with:
In-vitro fertilisation (IVF)
History of pelvic infections → salpingitis
Previous ectopic pregnancies
Damaged fallopian tubes, e.g., from adhesions or scarring
History of previous gynaecological surgery
Woman who become pregnant while using an IUD or taking the progesterone only pill
Infertility
Ectopic Pregnancy
Clinical Manifestations
Clinical manifestations of an ectopic pregnancy usually occur 6-8 weeks after the last normal menstruation:
Abdominal pain → usually left / right lower quadrant
A missed menstrual period
Vaginal bleeding, which may be minimal
Symptoms of pregnancy → breast tenderness, frequent urination, or nausea
Feelings of dizziness or light-headedness
Signs and symptoms of haemorrhage → collapse, tachycardia, hypotension
Ectopic Pregnancy Outcomes
In some cases, the fertilised egg dies quickly and is broken down systematically before symptoms occur → ectopic pregnancy in these cases are rarely diagnosed → no treatment / management required
If the fertilised egg continues to grow, the fallopian tube will stretch → clinical manifestations will be experienced tube will rupture → internal bleeding → urgent surgery required to remove the fallopian tube and fertilised egg
Ectopic Pregnancy
Diagnosis & Treatment
Health history
Ultrasound scan
Pregnancy test
3 treatment options
→ Keyhole laparotomy → to remove fertilised egg from the fallopian tube
→ Laparotomy → to remove ectopic pregnancy option determine if pregnancy has advanced and there is significant haemorrhaging
→ IM injection of methotrexate → option for cases that are asymptomatic or mild symptoms → dissolves pregnancy to avoid surgery
Ectopic Pregnancy Nursing Care
Pre and post operative care → monitor vital signs as per guidelines, assess for shock, wound care, DVT prevention, fluid support, analgesia
Educating your patient around the procedure and any side effects, especially of using medication therapy to treat the ectopic pregnancy.
Emotional support and education.
The male reproductive system is also broken down into primary, or essential, organs and secondary organs.
The primary organs are the testes
Secondary organs include the epididymis, urethra, ejaculatory duct, prostate gland, seminal vesicles, the penis and the scrotum.
Those that were assigned male at birth, men who have transitioned to a woman and non-binary people can also have, or had, male reproductive organs and be impacted by disorders related to this body system.
There are 3 primary functions of the male reproductive system:
Produce and secrete male sex hormones
Produce and maintain sperm and semen
Transport semen into the female reproductive tract
Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is an age related condition in which there is abnormal prostate cell proliferation, resulting in an abnormally enlarged prostate with associated prostatic tissue expansion. Due to the enlargement of this prostatic tissue, prostatic urethra compression occurs resulting in urinary system dysfunction and lower urinary tract symptoms (LUTS). This will include thickening of the bladder wall, interrupted urine flow and incomplete bladder emptying.
Exact aetiology is unknown
Mortality rate is low
Associated with severeLUTS and sexual dysfunction
Significant impact on quality of life
Sadness
Depression
Anxiety
Body image changes
Benign Prostatic Hyperplasia
Risk Factors
Age >50 → risk will continue to rise with age → hormonal changes associated with aging
Male family member with BPH
Obesity and sedentary lifestyle
Erectile dysfunction
Metabolic syndrome
Frequent urinary tract infections
History of cardiovascular disease and T2D
Benign Prostatic Hyperplasia
Clinical Manifestations
The clinical manifestation associated with BPH occur gradually and can be dividing into 2 categories:
Obstructive → voiding related issues → urethral constriction from enlarged prostate gland:
Reduced flow
Feelings of incomplete emptying
Post-void dribbling
Straining to void
Urinary intermittency
Hesitancy
Irritative → bladder and urinary storage issues → increased force required to urinate → detrusor muscle hypertrophy → thickening and hardening of the bladder wall → loss of elasticity and reduction in compliance:
Nocturia
Urinary frequency
Urgency
Dysuria
Bladder pain
Urge incontinence
Benign Prostatic Hyperplasia
Complications
Urinary retention → sudden and painful inability to urinate → urgent intervention required → insertion of IDC
Frequent urinary tract infections → related to inability to empty bladder → bacterial growth → can result in sepsis
Bladder calculi → occurs due to alkalinisation of residual urine
Acute kidney injury → can lead to kidney failure → caused by hydronephrosis from urine unable to be voided
Benign Prostatic Hyperplasia
Diagnosis
Health history and physical assessment
Digital rectal examination (DRE) → performed to estimate size & symmetry of prostate
Urinalysis → to determine blood and presence of inflammatory cells → WBC & RBC
Prostate-specific antigen (PSA) blood test → slightly elevated with BPH → can significantly rise with prostate cancer
Routine bloods → renal function test → kidney function and inflammatory mediators → creatinine
Transrectal ultrasound→ ordered if PSA elevated and abnormalities detected with DRE → allows for accurate assessment of prostate size and for differentiating with prostate cancer
Cystoscopy → internal visualisation of the urethra and bladder → can be used to confirm diagnosis
Benign Prostatic Hyperplasia
Treatment
Goals of treatment
→ Restore bladder function, particularly drainage
→ Symptom management
→ Prevent complications
Treatment plan will be based on symptom severity and history of complications, not the size of the prostate
Active surveillance → watch & wait → chosen if the patient is relatively asymptomatic → focuses on lifestyle changes (avoiding spicy food, increase exercise, weight reduction, decrease fluid intake at night), education and routine reviews
Timed voiding → scheduling specific times for voiding → going to the toilet to void based on a fixed time as opposed to sensation to urinate → can help the individual to regain bladder control → can reduce symptoms → reduces the need for medication or more invasive interventions
Double voiding → relax before urination to reduce anxiety and tension → urinate, relax for a few minutes, then attempt again
Medication therapy → designed to reduce size of prostate and minimise symptoms
→ 5α-reductase inhibitors
→ α-adrenergic receptor blockers
→ combination therapy
Surgery
→ Transurethral resection of the prostate → removal of prostate tissue through the urethra → gold standard for surgical intervention
Postoperative complications → pain, bleeding and clot retention, transurethral resection syndrome, retrograde ejaculation
Erectile dysfunction unlikely
→ Open prostatectomy → option for men with enlarged bladders and other complicating factors
Often results in erectile dysfunction, increased risk of infection, long term urinary incontinence and significant postoperative pain, bleeding, and clot retention
Benign Prostatic Hyperplasia
Nursing Management
Nursing care is rarely required unless admission to hospital is needed for investigations or surgical intervention. Nursing care considerations relate to pre and postoperative care:
Health history → subjection and objective data collection → major illnesses, previous surgeries, medication history, previous STIs, current symptoms, urinary output history, sexual function, pain history
Symptom management and education
Preoperative
→ Education → the type of surgery, why it is needed, the benefits, complications/risks and if they have any concerns or questions.
→ Assessments
→ Prophylactic antibiotics administration may be required
→ Maintaining fluid intake until NBM.
Postoperatively
→ Postoperative assessments → as per usual postoperative nursing care considerations and guidelines
→ Bladder irrigation
Aim is to reduce the risk of occlusion and urinary retention from clotted blood from the bladder and to ensure drainage of the urine → blood clots are expected in the first 24 - 36 hours postoperatively.
→ Pain management – bladder spasms are common.
→ Fluid balance management
→ Reducing risk of infection
→ Discharge planning
Bladder irrigation
Common post-surgery
Aim is to reduce the risk of occlusion and urinary retention from clotted blood from the bladder and to ensure drainage of the urine → blood clots are expected in the first 24 - 36 hours postoperatively.
May be intermittent or continuous.
Nursing care considerations:
Care as per all IDC care & considerations
Assess for bleeding & clots
Assess catheter patency
Strict FBC with input and output hourly measures
Manually irrigate if bladder spasms occur or with decreased output
If IDC becomes obstructed → discontinue and escalate to medical team
Education
Prostatitis
Prostatitis is an umbrella term that includes a group of inflammatory and non-inflammatory disorders of the prostate gland. While prostatitis can affect men of all ages, these conditions are the most common urological issue for younger men, being mostly prevalent between the ages of 36-50 years.
Can be diagnosed as either acute or chronic, bacterial, or non-bacterial
Symptoms can occur without signs of infection.
There are four classifications of prostatitis, including:
Acute bacterial prostatitis
Chronic bacterial prostatitis
Chronic prostatitis/chronic pelvic pain syndrome → urinary & prostate pain with an absence of an infectious process → may occur after a viral infection → also associated with recent STI
Asymptomatic inflammatory prostatitis → no symptoms are experienced with this type of prostatitis, but inflammatory processes of the prostate occur and are evident with medical assessment
Acute or chronic prostatitis can occur when an organism reaches the prostate gland either by ascending the urethra, descending from the bladder, or invading the bloodstream.
Most common organisms include:
Escherichia coli → most common
Klebsiella
Pseudomonas
Enterobacter
chlamydia trachomatis
Neisseria gonorrhoeae
Prostatitis
Clinical Manifestations
If infectious cause → fever, rigours, chills
Back pain
Perineal pain
Acute urinary symptoms → dysuria, urinary frequency, urgency, cloudy urine
Urinary retention
Severely inflamed prostate → swollen, boggy, painful to touch
Prostatitis
Complications
Erectile dysfunction
Epididymitis
Cystitis
Post-ejaculation pain
Decreased libido
Prostatic abscess
Irritative voiding symptoms → dysuria, urinary frequency, urgency
Recurrent UTIs
Prostatitis
Diagnosis
Health history & full physical assessment
Urinalysis
Urine culture & sensitivity
Routine bloods +/- blood cultures
Prostatitis
Nursing Management
Acute management usually involves hospital admission for administration of IV antibiotics → trimethoprim, ciprofloxacin, cefalexin, doxycycline orally for 4 weeks once discharged
Antibiotic therapy continues for 8 - 12 weeks
Infection / fever management
Pharmacological pain management → NSAID & simple analgesia → pain can last months with chronic prostatitis
Non-pharmacological pain management → sitz baths, heat packs → ejaculation can reduce pain (best not to practice while in hospital)
Repetitive prostatic massage - removes excess prostate secretions.
Education → associated with antibiotics, symptom management, encourage increased fluid intake
Hydrocele
Scrotal swelling caused by a collection of fluid within the tunica vaginalis
Hydrocele
Causes
Congenital → chronic hydrocoele → men >40 years → imbalance between production and reabsorption of fluid
Acquired → trauma, infection, tumour
Hydrocele
Clinical Manifestations
Increased scrotal mass
Usually painless but can experience a dull ache in the scrotum
Difficulty walking
Progressive heaviness
Epididymitis
Acute, painful inflammation of the epididymis
Usually caused by a infection, trauma, urinary reflux
gonorrhoea, chlamydia, E.coli
Mostly unilateral
Swelling will often increase until epididymis and testis are indistinguishable
Treated with oral antibiotics if STI related
Otherwise → bed rest, elevation of scrotum, ice packs, analgesia
Orchitis
Acute inflammation of the testis
Clinical manifestations include painful swollen testes
Often occurs after a bacterial or viral infection → mumps, syphilis, tuberculosis, epididymitis
Can also occur after trauma such as catheterisation
Treatment as per epididymitis
Concurrent orchitis with epididymitis → epididymoorchitis
Testicular Torsion
Twisting of the spermatic cord that supplies blood to the testes and epididymis
Medical emergency due to loss of blood supply, requiring urgent surgical intervention → ischaemia occurs within 4-6 hours
More common in males <20 years
Can occur spontaneously, from an anatomical abnormality or as a result of trauma
Associated with severe, unilateral scrotal pain, tenderness, swelling, nausea and vomiting
Male Infertility
Infertility is considered as a disorder that affects a couple, that being both the male and female. For this reason, both partners need to be tested when infertility is considered to determine which partner the infertility relates to. Approximately ⅓ of infertility is caused by the factors affecting the man.
In general, male infertility can be caused by a number of different factors including:
Anatomical or genetic abnormalities
Systemic or neurological diseases
Infections
Trauma
Iatrogenic injury
Gonadotoxins
Development of sperm antibodies
Vasectomy
A vasectomy is a simple surgical procedure where bilateral vas deferens (vas) are cut to cause sterilisation.
Prevents the flow of sperm into the ejaculate.
The procedure can be performed with local anesthetic in a clinic or as an outpatient or with general anaesthic as a day patient → takes 15 - 30 minutes
Considered permanent but can be reversed in some cases.
Does not affect production of hormones, ability to ejaculate or the ability to develop an erection
Vasectomy
Nursing Management
Standard nursing pre and postoperative care is required if general anaesthetic is to be administered
Shave the area pre-operatively.
Pharmacological pain management → paracetamol and ibuprofen.
Non-pharmacological pain managment include the use of ice packs → frozen pea’s make a great ice pack!
Education → postoperative self-care
What is Sexual Health
Sexual health is relevant throughout a person’s life, from adolescence into older age. It encompasses physical, emotional, mental, and social well-being related to sexuality. It’s not just about the absence of disease; it also involves positive and respectful sexual relationships, pleasurable experiences, and the fulfillment of sexual rights. Neglecting sexual health can lead to serious consequences, such as infertility, ectopic pregnancy, preterm birth, neonatal death, pelvic inflammatory disease, depression and anxiety, impaired urological function and haematological dysfunction. Sexual health is an essential aspect of overall well-being, impacting individuals, couples, families, and communities.
Sexuality is a human right. It consists of sex, identity, gender role, sexual orientation, intimacy and reproduction. Every individual has the right to make personal decisions related to their sexual health.
Maintaining good sexual health requires:
Access to accurate and reliable information
Knowledge about risks and consequences of unprotected sex
Practicing safe sex
Equal access to inclusive and safe healthcare
According to the Department of Health and Aged Care (2023), sexual health includes:
Respect for the right to healthy relationships, equality, and safety
Safety to express individual sexuality, sexual orientation, and gender identity
Freedom from coercion, discrimination, violence, and stigma
Access to information and health care
Protection from, and treatment of, STIs
Key Nursing Care Considerations sexual health history
Obtaining an in-depth sexual health history is not always necessary. But there are times when it is an important part of a focused health assessment. You don’t need to know everything about your patient’s sexual health and what you do need to know, depends on their concerns. To guide your approach, consider obtaining some background history prior to your patient encounter. You can then target your health history questions to what you do need to know.
Environment
Dialogue
Consider the 5 P’s to guide your assessment
End of Assessment
Environment
Create a welcoming, safe, trustful environment
Identify yourself and your role → #hellomynameis
Establish your patient’s name
Ask their sexual orientation / gender identity / sex assigned at birth → these are not the same and should be asked separately → it is okay if your patient declines to answer
Never make assumptions
We are not to make judgements on our patients → keep your opinion to yourself
If you are embarassed by asking direct questions about sexual health, your patient will pick up on this and you will loose the opportunity of having a trustful, open discussion. Your patient will not feel safe to talk openly and honestly with you.
Consider how the following will influence your assessment:
Culture
Age
Domestic Violence
Dialogue
Consider the language you use → use common language
Use open-ended questions that are focused on the information you need
Start the discussion with a introduction and gain your patient’s permission to continue.
Acknowledge that the questions you are going to ask are very personal but that they are an important part of your nursing assessment.
Let your patient know that you ask these same questions with all patients regardless of age, gender, sex, marital status, orientation, profession
Reassure your patient that the information they provide is strictly confidential, unless someone is being hurt or in danger, and that you are not there to pass judgement, just to provide holistic person-centered care
May I ask you some questions about your sexual health?
I’d like to ask some questions about your sexual life. Would that be okay?
Do you have any questions before we get started?
Do you have any concerns about your sexual health?
Consider the 5 P’s to guide your assessment:
Partners
Practices
Protection
Past history of STIs
Pregnancy intentions
Additional considerations when obtaining a sexual health history from a female:
Menstrual history
→ Date of first day of her last period
→ Menstrual flow and problems (any changes)
→ Age of menarche/menopause
Pregnancy history
→ Number of pregnancies
→ Number of living children
→ Number or pregnancy losses
→ Gestational age of birth
→ What sort of birth did you have (vaginal, caesarean, assisted forceps or vacuum)
Are you taking hormone replacement therapy?
Partners
Used to assess risk of STIs
Determine number and gender of sex partners and risk factors such as drug / alcohol use and concurrent partners
Have you had/are you having sex of any kind? If so - oral, anal, vaginal?
In the last 3 months, how many sex partners have you had?
What is/are the gender/s of your sex partners?
Do you or your partner currently have other sex partners?
Practices
Guides assessment of risk, risk-reduction strategies, and interventions such as testing and what sites of the body need to be tested
When was the last time you had sex?
What kind of sexual contact do you have/have had? What parts of your body are involved when you have sex?
Do you have genital / anal / oral / top and/or bottom sex?
Do you meet your partners online?
Do you exchange money/drugs/housing for sex?
Protection
Used to determine level of STI risk and risk-reduction needed
Do you discuss STI prevention?
What do you use to prevent STIs
How often do you use these? If only sometimes, can you talk me through your decision?
Have you had your vaccinations against hepatitis?
Are you aware of PrEP, a medication that can prevent HIV?
Past history of STIs
Used to understand your patient’s risk
Have you ever been tested for STIs?
Have you ever been diagnosed with an STI?
Have you been experiencing any symptoms? If so, have you had these checked?
Has your recent/current partner every been diagnosed for an STI?
Do you know your partner’s HIV status?
Pregnancy intentions
Based on the responses, you can determine your patient’s risk of becoming pregnant
Do you think you would like to have children at some point?
When do you think that may be?
How important is pregnancy to you?
Are you using contraception? If so, what type?
Condoms
Hormonal methods
Barrier method
Intrauterine device
‘Natural’ method
Sterilisation
Emergency contraception
‘Pull out’ method
End of Assessment
Thank your patient for their honesty and for being open
Your patient may have some additional questions that they were not ready to discuss earlier
→ Acknowledge and provide responses as best you can
→ If you don’t have the answer → refer → do not dismiss
Eduction
→ Treatment options
→ Symptom management → depends on diagnosis but can include:
→ Simple analgesia, NSAIDs, opioid analgesics
→ Heat packs, Sitz baths, Rest
→ Sexual abstinence until infection is cured
→ Avoid sexual contact with partners from at least the last 2 months until they have been tested
→ Partner notification → provide support for this discussion
→ Prevention - condoms must be used even if other forms of birth control are used, contraception
→ Support groups
→ How to get help
→ Handouts
→ Importance of follow up reviews and testing
Encourage safe practices and illness prevention → be proactive
Sexually Transmitted Infections
Sexually transmitted infections are those that are caused by a virus, bacteria, fungi, protozoa, or parasite with the portal of entry being the mouth, genitalia, urinary meatus, anus, rectum and skin. These infections are a major public health concern in Australia, with the focus being on prevention and control.
Approximately 16% of Australians have had an STI in their lifetime
In 2020, >29 000 Australians were living with HIV
In 2020, there were approximately 57 500 new STIs among females and 67 400 among males
By 2019, STI notification rates increased 79% for gonorrhoea and 95% for infectious syphilis
The prevention and control of STIs are based on the following principles:
Education / prevention
Early detection
Diagnosis
Treatment of the infection (bacterial, viral, fungi, parasite)
Counselling of sexual partners of people who are infected.
Although STIs are caused by differing organisms, they have several common characteristics:
Transmission occurs during sexual activity → can be non-penetrating in nature.
Sexual partners of the infected person must also be treated
> 2 STIs can co-exist in the one person
At risk groups for STIs
< 25 years
Aboriginal and Torres Strait Islander people
Pacific Islander people
Men who have sex with men
Sex workers
People who inject drugs
Bacterial STIs
Bacterial STIs can result in serious health consequences, increasing the risk of:
Acquiring HIV
Mother-baby transmission → stillbirth, neonatal death, congenital syphilis
Pelvic inflammatory disease
Infertility
Some important facts about bacterial STIs:
They can be cured with antibiotics
<25 years and those from culturally and linguistically diverse backgrounds have higher reported rates of infection
Barriers to review, assessment & treatment include: culture, concerns about discrimination, stigma, and language barriers
Gonorrhoea
Bacterial STI
Cause → Neisseria gonorrhoea
Notifiable infection → major public health challenge
Highest rates → men who have sex with men, young heterosexuals, Aboriginal and Torres Strait Islander people living in remote and very remote communities
Previous infection does not provide immunity to new infection
Spread → sexual contact with an infected person → vaginal, oral, anal
Incubation → 3-8 days
Gonorrhoea
Clinical Manifestations
Men: dysuria, penis urethral discharge serous/milky/purulent
Women: dysuria, urinary frequency, abnormal menses, increased vaginal discharge, dyspareunia
Conjunctivitis → purulent → sight-threatening
Gonorrhoea
Complications
Epididymoorchitis
Prostatitis
Pelvic inflammatory disease
Bartholin gland abscess
Meningitis
Endocarditis
Mother-baby transmission
Gonorrhoea
Diagnosis
First-pass urine test
Swabs → penile urethral, self-collected vaginal, clinician-collected endocervical, anorectal, pharyngeal
Gonorrhoea
Treatment
Swabs collected prior to commencing antibiotics but treatment is not delayed while waiting for results
Oral + IMI antibiotics → increasingly resistant to penicillins, sulphonamides and tetracyclines
Ceftriaxone → IMI
Azithromycin → PO
No sexual contact for 7 days
No sex with partners from last 2 months until they have been tested
Partner notification recommended
Follow up in 1 week
Syphilis
Bacterial STIs
Cause → Treponema pallidum
Highly infectious, transmissible, and contagious infection → during the first 2 years → if left untreated, will cause serious, systemic problems
Notifiable infection → major public health challenge due to increasing rates
Spread → skin to skin contact during unprotected sexual contact with an infected person → vaginal, oral, anal sex
Highest rates → men who have sex with men,
Aboriginal and Torres Strait Islander people living in remote and very remote communities and general population living in major cities
50% of people will be asymptomatic
4 stages
4 stages of Syphilis
Primary stage
Secondary stage
Latent stage
Tertiary stage
Syphilis
Primary stage
Incubation period 14-21 days
Small, round, firm and painless lesions called chancre erupt at the site of infection usually 3 weeks after infection → can be in the mouth, anus, genitals, cervix, or on the fingers
Last for 3-6 months and heal spontaneously
Without treatment, will lead to secondary syphilis
Syphilis
Secondary stage
Associated with rash (reddish/brown spots usually found on palms of hands & soles of feet), skin lesions, fever, sore throat, lymphadenopathy, arthralgia, large grey/white wart-like papules develop on warm moist areas such as labia, anus or corner of mouth and axilla, flu like symptoms, lethargy, and alopecia.
Symptoms last 3-12 weeks and can spontaneously resolve
Without treatment, person will be infectious for up to 2 years and then transition into latent stage
Syphilis
Latent stage
Begins when clinical manifestations associated with secondary stage have disappeared → usually 12 - 24 months after initial infection
Asymptomatic but person still infectious
Without treatment, can remain latent for life or will progress to tertiary stage
Syphilis
Tertiary stage
Occurs with approximately ⅓ of infected people
Clinical manifestations can appear up to 30 years after exposure
Disease will involve multi-systems → brain, CNS, eyes, cardiovascular system, liver, bones, and joints → degree of severity depends on organ system affected
Often fatal
No longer infectious
Syphilis
Complications
Infection during pregnancy → mother-baby transmission → congenital syphilis → severe multi-organ disease with very high mortality and morbidity
Early neurosyphilis → involves CNS → blindness, tinnitus, deafness, meningitis
Syphilis
Diagnosis
Blood test
Swab of lesions → repeated after 2 weeks if suspicious
History and clinical assessment
Syphilis
Treatment
IMI antibiotics → benzathine benzylpenicillin
No sexual contact for 7 days after treatment has commenced
No sex with partners from last 3 months, 6 months or 12 months (depending on phase) until they have been tested
Partner notification recommended
Repeat testing required at 3, 6 and 12 months
Chlamydia
Bacterial STIs
Cause → Chlamydia trachomatis
Most reported communicable disease in Australia
Spread → vaginal, anal, or oral sex with someone who is infected
Highest rates → <30 years men and women
Incubation → 7 - 21 days but can be up to several months
Chlamydia
Clinical Manifestations
→ occur 2-14 days after infection
Almost 90% of cases are asymptomatic → still infectious and can transmit
Dysuria, anal discharge
Men → penile urethral discharge, testicular pain, swollen testicles
Women → vaginal discharge, pelvic pain, intermenstrual bleeding, postcoital bleeding, dyspareunia, anorectal symptoms
Chlamydia
Complications
Mother-baby transmission
Epididymoorchitis
Pelvic inflammatory disease
Infertility
Ectopic pregnancy
Conjunctivitis
Pelvic adhesions
Chronic pelvic pain
Recurrent urethritis in men
arthritis
Chlamydia
Diagnosis
First-pass urine test
Penile urethral swab
Self-collected vaginal swab
Clinician-collected endocervical swab
Anorectal swab
Pharyngeal swab
Chlamydia
Treatment
Oral antibiotics → doxycycline for 7 days
Full STI check
Avoid sexual contact for 7 days
No sex with partners from last 6 months until they have been tested
Partner notification
Follow up → retesting in 3 months → reinfection is common
Pelvic Inflammatory Disease
A syndrome of inflammatory disorders that occur when an infection spreads from the vagina to the upper genital tract → may involve cervix, ovaries, fallopian tubes, and pelvic peritoneum.
Causes → polymicrobial, STIs and bacterial vaginitis → 70% of cases have no identifiable cause
Up to 20% of women with untreated chlamydia can develop PID
Highest risk → < 30 years
Pelvic Inflammatory Disease
Clinical Manifestations
Gradually increasing pelvic pain → typically bilateral, but can be unilateral → is worse on movement → refers to RUQ
Deep dyspareunia
Vaginal/cervical discharge → blood stained or purulent
Post coital vaginal bleeding
Intermenstrual bleeding
Fever
Nausea and vomiting
Pelvic Inflammatory Disease
Diagnosis
Health history and clinical assessment with pelvic examination
Endocervical swab
Pelvic Inflammatory Disease
Treatment
Oral + IMI antibiotics
Ceftriaxone IMI + metronidazole PO + doxycycline PO
Severe cases will require IV antibiotic treatment
Treatment is not delayed for results
Avoid sexual contact for 7 days
Rest
Simple analgesia
Viral STIs
Just like bacterial STIs, viral STIs are associated with a gamut of clinical manifestations, some of which are very serious and life-threatening. Viruses are:
Smaller organisms than bacteria
Need a living host to reproduce
When entering the body, they invade cells and manipulate them to reproduce
Cannot be treated with antibiotics
Viral STIs include genital herpes, anogenital warts, human immunodeficiency virus (HIV) and Hepatitis B and C.
Anogenital Warts
Viral STIs
Cause → human papillomavirus (HPV)
Spread → direct skin to skin contact with lesions and genital secretions → micro-abrasions allow viral access
Not a notifiable disease
Incubation period → 2-3 months
Anogenital Warts
Clinical Manifestations
Most cases are asymptomatic
Wart-like growths or lesions, in and around anogenital area or mouth
Lesions can be itchy, slightly painful
Perianal itch
Rectal bleeding after using bowels
Distorted urinary stream
Bleeding from lesions
Can cause significant psychological distress
Anogenital Warts
Complications
Can become malignant → cervical, anal, penile, vaginal, oropharynx cancer
Anogenital Warts
Diagnosis
Health history and clinical examination → visual inspection
Lesion biopsy
Anogenital Warts
Treatment
Wart paint applied topically
Avoid shaving or waxing over lesions will → facilitate spread
Health prevention → HPV vaccination administered to girls in high school
Genital Herpes
Viral STIs
Incurable → life long disease → can remain dormant and inactive for many years but will remain live in the nerve pathways (dorsal root ganglia) for life
Characterised by typical herpetic infectious process → primary lesion eruption → period of latency → reactivation → local reoccurence close to site of initial portal on entry
→ Reoccurence precipitated periods of extreme stress, trauma, intercurrent disease, environmental factors and immunosuppression
Notification is not required
Cause → 2 organisms → a person can be infected by both organisms
Herpes simplex virus (HSV) type 1 → referred to as cold sores → most common with 75:100 Australians having HSV 1
HSV type 2 → referred to as genital herpes → not as common with 12:100 Australians having HSV 2
Highly stigmatised & poorly understood in the community
Spread → direct skin to skin contact, entry via micro abrasions in the skin
Incubation period → 2-12 days
Genital Herpes
Clinical Manifestations
→ depends on portal of entry, age, immune status and type
Both types begin with early warning signs → tingling, itching, and pain in the infected area → followed by eruption of clusters of blisters (clear vesicles) → lesions ulcerate → then crust and heal → process lasts approximately 1 week
HSV 1
Usually found on lips and mouth → can also be transmitted to the genital / anus region
Primary infection can be mild → 10% of cases will be severe and associated with fever and malaise
HSV 2
Usually found around the anus, perineum, genitals, cervix, vulva → can also be transmitted to the lips and mouth
Secondary infections can be found on the lower back, legs, thighs and buttocks
Genital Herpes
Complications
Erythema multiforme
Bell’s palsy
Chronic cutaneous infection with crusted lesions located on visceral organs
Severe system toxicity
Lymphadenopathy
Pneumonitis
Radiculitis
Hepatitis
Aseptic meningitis
Encephalitis
Sacral radiculopathy
Genital Herpes
Diagnosis
Swab of lesions
Blood test → HSV1 and HSV2
Genital Herpes
Treatment
Antiviral medication → valacyclovir or acyclovir PO → supresses symptoms only → doesn’t cure
Analgesia
Topical lignocaine
Avoid sexual contact until symptoms resolved
Human Immunodeficiency Virus (HIV)
Viral STIs
Cause → human immunodeficiency virus → single-stranded RNA virus
Notifiable infection → contract tracing is important to prevent re-infection
Spread → direct contact with body fluids (blood, semen, anogenital fluid) from an infected person who has a viral load must enter through and open wound, direct injection or a mucous membrane (rectum, vagina, tip of penis, mouth) → can also be transmitted mother to baby during pregnancy or when breastfeeding
Human Immunodeficiency Virus (HIV)
Clinical Manifestations
Acute infection → lasts up to 2 weeks
fever, rash, lymphadenopathy, pharyngitis, myalgia, diarrhoea
Can be asymptomatic after initial seroconversion → can last several years
Immune deficiency
oral thrush, diarrhoea, weight loss, skin infections, herpes
Human Immunodeficiency Virus (HIV)
Complications
After 10 years of infection (but can be between 2-20 years)
Chronic immune deficiency
Acquired immunodeficiency syndrome → AIDS
Opportunistic infections
pneumocystis, oesophageal candidiasis, cerebral toxoplasmosis, skin cancers
Cardiovascular disease
Chronic kidney disease
Osteoporosis
non-AIDS malignancies
Human Immunodeficiency Virus (HIV)
Diagnosis
Blood tests → tools have been developed to assist with guidelines for diagnosis, decision-making and management
Human Immunodeficiency Virus (HIV)
Treatment
Antiretroviral therapy (ART) → taken daily, for life
Post-exposure prophylaxis (PEP) → offered within 72 hours of potential exposure
Pre-exposure prophylaxis (PrEP) → offered to high-risk people to reduce risk of infection
Close follow up required → once stable, follow-up required every 3-6 months
Viral STIs
Hepatitis
Hepatitis means swelling of the liver
Can occur from infectious or non-infectious sources → viruses, alcohol, drugs, impaired immune system, and other toxins
5 types (strains)
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D and Hepatitis E are the remaining types of hepatitis → you can complete your own research on these types
Hepatitis A
Acute liver infection → results in lifelong immunity → does not cause chronic hepatitis
Source → hepatitis A virus → HAV
Highly contagious
Transmission → faecal-oral transmission → during sexual contract or contaminated food and water
Incubation → 15-50 days → average 28 days
Infectious period → 2 weeks before onset of symptoms to 1 week after onset of jaundice
Clinical Manifestations → fever, malaise, lethargy, nausea, jaundice, pale stools, dark urine → resolves within 1 month
Complications → liver failure
Diagnosis → blood test → liver function, hepatitis antibodies screen
Treatment
Conservative → symptomatic management
No sexual contact during acute illness and for 1 week after onset of jaundice
Risk of occupational transmission
Contact tracing → back 50 days
Follow up
Prevention → vaccination
Hepatitis B
Acute liver infection → highly infectious, vaccine preventable → does not cause chronic hepatitis
Source → hepatitis B virus → HBV
Mostly a short-term illness → 95% of infected adults will completely recover → can lead to a chronic, life-long infection
Transmission → Percutaneous, mucosal, blood, semen, or other bodily fluids of an infected person through sexual contact, sharing contaminated needles or childbirth→ entry to liver through bloodstream
Incubation → 40-90 days → average 60 days
Infectious period → up to 3 months before symptoms develop and until infection eliminated → virus will remain infectious for 7 days on the surface of the skin
Clinical Manifestations → fever, malaise, lethargy, nausea, anorexia, abdominal pain, jaundice, pale stools, dark urine, arthralgia
Complications → chronic liver failure, cirrhosis, liver cancer, death
Diagnosis → blood test → liver function, hepatitis antibodies screen
Treatment
Conservative → symptomatic management
No sexual contact during acute illness and for 1 week after onset of jaundice
Risk of occupational transmission
Contact tracing
Hepatitis C
Source → hepatitis C virus → HCV
Transmission → blood to blood contact from skin penetration → contaminated needles, sexual contact (oral, anal and vaginal), unscreened blood transfusions, sharing toothbrushes or razors → amount of blood needed for transmission is microscopic
95% of HCV cases can be cured through antiviral medications
Incubation → 15-50 days → average 28 days
Infectious period → 3 weeks prior to the onset of symptoms
Clinical Manifestations → mostly asymptomatic → occasionally, upper right quadrant pain, fever, malaise, lethargy, anorexia, jaundice, pale stools, dark urine → can last up to 6 months
Complications → chronic liver failure, cirrhosis, liver cancer
Diagnosis → blood test → liver function, hepatitis antibodies screen
Treatment
Symptomatic management
Direct acting antivirals (DAAs)
Contact tracing
Partner notification
Prevention → no vaccination available, avoid risky behaviours
Fungal & Protozoan STIs
Trichomoniasis
Candidiasis
Trichomoniasis
Source → trichomonas vaginalis → a protozoan
Common in older people living in regional and remote areas
Affects the vagina, urethra and paraurethral glands
Transmission → sexual contact with an infected person → oral, vaginal and anal
Incubation → 3 - 28 days
Trichomoniasis
Clinical manifestations
50% of cases are asymptomatic
Urethritis
Urethral discharge
Dysuria
Malodourous vaginal discharge → profuse and frothy
Vulval itch and discomfort
Trichomoniasis
Complications
Prostatitis
Vaginitis
Increases risk of contracting HIV
Pregnancy related → premature ruputre of membranes with pregnancy, low-birth weight, post-partum sepsis
Trichomoniasis
Diagnosis
High vaginal swab
First-pass urine test
Trichomoniasis
Treatment
Oral antibiotics → metronidazole
Avoid sexual contact for 7 days after treatment has commenced
Treat sexual partner
Follow up review in 7 days
Retest after 4 weeks
Candidiasis
Source → candida albicans → fungal infection → can be normal flora
Transmission → sexual contacxt but not considered a STI
Candidiasis
Clinical Manifestations
Excoriation and erythema
Rash on genitals → often itchy
Swelling of the foreskin
Fissures, superficial erosions
Thick, white clumping vaginal discharge
Genital burning and soreness
Superficial dyspareunia
External dysuria
Candidiasis
Diagnosis
Swabs → high-vaginal, penis, self-collected
Candidiasis
Treatment
PO antifungal medication
Anti-fungal vaginal cream → applied nocte intravaginally
Hydrocortisone cream to reduce itch
Which of the following procedures may be used in the management of an enlarged or diseased prostate?
Prostatectomy
Orchidectomy
Vasectomy
Digital rectal examination
Prostatectomy
Hesitancy or difficulty initiating voiding, dribbling at the end of urination and starting/stopping urination are lower urinary tract symptoms (LUTS) that occur as a result of which of the following?
Endometriosis
Polycystic ovary syndrome
Obstruction
Testicular torsion
Obstruction
Which of the following conditions affects 1 in 6 women under the age of 30 and has associated clinical manifestations including oligomenorrhoea, amenorrhoea and acne? Levels of luteinising hormone and testosterone are used to make the diagnosis.
Ovarian cancer
Endometriosis
Polycystic ovary syndrome
Pelvic inflammatory disease
Polycystic ovary syndrome
Which of the following conditions is characteristically found in young women aged between 25 and 35 years who have not given birth? Clinical manifestations can include dysmenorrhoea, dyspareunia and dysuria. Diagnosis generally requires an ultrasound +/- laparoscopy .
Ovarian cancer
Endometriosis
Polycystic ovary syndrome
Pelvic inflammatory disease
Endometriosis
Which of the following medications are used to relax the prostate and the bladder to improve lower urinary tract symptoms?
Prostate specific antigen blocker
5 alpha-reductase inhibitors
Alpha adrenergic receptor blocker
Testosterone receptor angonists
Alpha adrenergic receptor blocker
Any vaginal (PV) bleeding other than spotting in the early stages of pregnancy is termed …….?
Incomplete miscarriage
Threatened miscarriage
Complete miscarriage
Endometriosis
Threatened miscarriage
Wing has been diagnosed with prostate cancer and now requires a radical prostatectomy. An adverse outcome that is associated with this procedure is erectile and ejaculation dysfunction. Wing, being only 46-years-old and newly married, is worried about his increased risk of infertility after the procedure. Considering Wing’s fears, which of the following should be explained to Wing?
Sexual function can gradually return over 2 years.
Sexual function is unlikely to return
Sexual dysfunction is unlikely to occur
Sexual dysfunction should resolve within 6 months
Sexual function can gradually return over 2 years.
Carter, formally known as Sarah, now identifies as male. He has been experiencing dysmenorrhoea and dyspareunia with low mood and lower back pain. Considering these clinical manifestations, Carter is most likely to be experiencing which of the following disorders?
Endometriosis
Prostate cancer
Bowel cancer
Polycystic ovarian syndrome
Endometriosis
For the last week, Tim, who is 17-years-old, has had a milky discharge from his penis with associated erythema around his meatus. Tim also describes persistent dysuria with constant pain in both testes. Of the following options, which would resolve this sexually transmitted infection?
Wart paint
Anti-viral medication
Ceftriaxone
Symptom management
Ceftriaxone
Oliver, 59-years-old has been having unprotected sexual intercourse with multiple male partners over the last six (6) months after a long-term relationship breakdown. For the last four (4) weeks, Oliver has struggled to recover from mild flu-like symptoms. He has been lethargic, had a sore throat, had painful joints, a headache and low-grade fever. Which of the following conditions does Oliver most likely have?
Primary syphilis
HIV
Hepatitis C
Herpes simplex virus
HIV
