WH Wellness Flashcards
The lack of menses
Amenorrhea
Crampy, intermittent, localized pain with menstruation. Localized pain to pelvic area but can radiate to back or thigs. Can result in fatigue, headache, diarrhea, nausea and malaise. Can be severe, especially with menarche and endometriosis. Often improves with age and after childbirth. Treat with NSAIDS, hormonal contraceptives, topical heat, exercise
Dysmenorrhea
The occurrence of the endometrial tissue outside of the uterus, usually in the pelvis. Can cause dyspareunia, dysmenorrhea, infertility, pelvic mass or pain. Diagnosed by surgical pathology. Presumptive treatment is with hormonnal contraception and NSAIDs or GnRH agonist. Alternative treatment is surgical excision or ablasion.
Endometriosis
A benign tumor of the uterus arising from myometrial cells. Usually asymptomatic. May cause menstrual changes or pelvic pressure. Can be surgically removed if symptomatic
Leiomyoma / Fibroids
An endocrine disorder involving ovulatory dysfunction and hyperandrogenism. Appears in adolescense and persists. Associated with diabetes, metabolic syndrome, cardiovascular disease, and endometrial cancer.
Polycystic ovarian syndrome (PCOS) General
A screening procedure for cervical cancer and cellular changes that can lead to cervical cancer done during a pelvic examination that involves scraping cells from the cervix for laboratory analysis to detect abnormal changes.
Pap smear
The identity of male or female assigned to a person at birth on the basis of that person’s genetics, hormone expression, and anatomic characteristics; also known as biologic or anatomic sex
Natal sex
A set of traits determined by culture and one’s own personal perception of one’s identity that is associated with femaleness or maleness
Gender
Having a gender identity that aligns with one’s anatomic sex at birth
Cisgender
A condition of distress or discomfort resulting from one’s gender identity not aligning with one’s anatomic sex; also known as gender incongruence
Gender dysphoria
A natural inclination to be sexually attracted to people of a given gender
Sexual orientation
Usually asymptomatic. S/s in men: urethritis. S/s in women: cervicitis, dysuria, vaginal discharge, pelvic pain (with PID)
EASY to treat with a single dose of oral antibiotics. Sexual partners must be treated or it will come right back. Positive cases are reported to state departments of public health. Can cause neonatal conjunctivitis and pneumonia
Chlamydia
Spread via direct contact: oral, anal, genital. Can have no s/s, can spread and cause PID. Can cause neonatal blindness, PTL, PROM. S/s for men: dysuria, testicular pain or edema, penile discharge. S/s for women: dysuria, vaginal discharge, irregular bleeding, pelvic pain.
3% of cases become disseminated: fever, chills, malaise, arthritis, pustules. Dx by culture. Easily treated by abx but resistance is developing. Treat sexual partners, co treat for chlamydia, retest for cure before sexual contact
Gonorrhea
A microscopic protozoan. Incidence 8-16% of women age 14-49. Half cases are asymptomatic. S/s: thin vaginal discharge, malodor, vulvar irritation, pelvic pain, dysuria.
Diagnosis: swimming protozoans seen under microscopy. EASY to treat: Flagyl (metronidazole) PO x1. Must treat sexual partners
Trichomoniasis / “Trich”
Physical, sexual, economic, verbal, and/or emotional abuse inflicted on someone by a current or former intimate partner. 36% of women in US experience this. Victims may not wish to disclose due to fear, shame, or desire to protect. Interview women privately and provide info they can take with them. May need to establish a trusting relationship before getting help. Pregnancy can be opportunity for change as victim will be motivated to protect baby. MOST DANGEROUS TIME IS WHEN VICTIM IS TRYING TO LEAVE. Support, dont judge, “you are not alone”
Intimate partner violence (IPV)
Types: Breast cancer (affects men too) Gynecologic cancers: cervical, ovarian, uterine, vaginal and vulvar AUB (abnormal uterine bleeding) Dysmenorrhea Fibroids Endometriosis Pelvic floor dysfunction PCOS
Special disorders and cancers that affect women
Low risk women in US have 12% lifetime risk
Genetic risk increaed with BRCA1 or BRCA2 gene variants (5-10% of cases)
These women need enhanced screening and are high risk for ovarian cancer.
Some genetic carriers may consider prophylaxctic salpingo-oophorectomy
Screening test is mammography (x-ray evaluation of breast tissue)
recommended q 1-2 years starting between ages 40-50 (varying guidelines)
Ultrasound and MRI can also be helpful
Clinical exams are often done annually after age 40 by gyn proviers, although their effectiveness is limited
Self exam is no longer recommended monthly, but “self awareness” is encouraged
Breast cancer
Risk increases with age. Treatment is hysterectomy with possible chemotherapy and radiation
Uterine cancer
Risk increases with age
caused by the virus HPV, graded CIN 1, 2, 3. Treatment for high grade lesions is removal of a portion of this (LEEP or cone biopsy); nvasive cancer may require hysterectomy, chemotherapy and radiation therapy
Cervical cancer
Risk increases with age. Leading cause of death from gyn cancers, rarely diagnosed in the early stages, there is no reliable screening, high risk women who do not have prophylactic surgery are followed with serial ultrasounds. Symptoms include abdominal pain and bloating, survival rates are poor: 46% live for 5 years, 33% live for 10 years, recurrences are common and lifelong surveillance is necessary
Ovarian cancer
Risk increases with age. Rare, associated with HPV, symptoms are vaginal bleeding
Vaginal cancer
Risk increases with age
Average age of diagnosis is 68 years, risk factors include other gyn cancer and smoking, compromised immunity.
Presenting symptom may be pruritis or visible plaque, diagnosed by biopsy, treatment is surgical
Vulvar cancer
Type of abnormal uterine bleeding (AUB). Lack of menarche by age 15, may be delayed puberty
Primary amenorrhea
Type of abnormal uterine bleeding (AUB). Absense of regular menses for 3 months or longer, illness, hypothyroidism, malnutrition, and emotional distress are common causes
Secondary amenorrhea
Type of abnormal uterine bleeding (AUB). Excessive menstrual bleeding resulting in anemia or fatigue, could represent coagulopathy
Menorrhagia
Type of abnormal uterine bleeding (AUB). Bleeding between periods, may be cyclic and normal or from lesions, infection, polyps, tumors, hormone disorders
Intermenstrual bleeding
This organ is a complex web of connective tissue and musculature which supports the pelvic organs. Relaxation of these muscles or damage to them can result in this organ prolapse. Prolapse can involve the bladder, rectum, bowels, or uterus. Risks increase with the number of vaginal births and obesity. Symptoms are vaginal pressure or pain, problems with coitus, defecation or urination. Treatment includes a vaginal pessary for support, physical therapy or surgical correction
Pelvic Floor Dysfunction
S/s: Menstrual irregularities, acne, hirsutism, polycystic ovaries, obesity, insulin resistance, thinning hair, depression, sleep apnea, abnormal lipid profile
Treatment: hormonal conception to regulate androgens, lifestyle changes for weight loss, metformin, spironolactone
Women may need fertility help due to chronic anovulation
S/s and Treatment of Polycystic Ovarian Syndrome (PCOS)
S/s: thin, white (or gray) vaginal discharge with “fishy” malodor after sex
Diagnosed on exam and with evaluation of discharge under microscope. Epithelial cells are studded with bacteria. Treated with oral or vaginal antibiotics
Bacterial Vaginosis (BV) S/S and Treatment
NOT an infection, rather an overgrowth of yeast. Fungal: usually candida albicans.
Diagnosed on exam and under microscopic exam. Yeast loves heat and sugar. More common in diabetics and with obesity (skin folds)
Vulvovaginal Candidiasis “yeast infection” General
Some yeast is NORMAL in the vagina, only treat the overgrowth with symptoms of excessive thick white clumpy discharge, irritation, erythema and ITCHING. Can be treated with oral and or vaginal antifungals. OTC treatments are available but may be less effective or too short in duration. Prevention: avoid hot constricting clothing, use cotton clothing, dietary supplements with live lactobacilli cultures (yogurt) might help
Vulvovaginal Candidiasis “yeast infection” S/S, Treatment, and Prevention
The most common STI. Many strains. Some cause visible genital warts (condyloma acuminata), some cause cervical cancer (the “high risk” strains), also causes cancer in the throat, anus, penis, vagina, and vulva. Spreads through direct intimate contract (vaginal, anal, oral sex)
Routine screening involves: visual inspection of skin and mucous membranes, viral testing, pap smears for cervical dysplasia (pre-cancer) or cancer cells at the cervix.
Other than painless warts there are NO symptoms until cervical changes begin
Human Papilloma Virus (HPV) General
No cure. Can only treat the manifestations. Most people will clear the virus on their own after several years.
Treatment for genital warts: topical acid, freezing, imiquimodm or podophyllin cream.
Pap smears should be performed every 3-5 years (Depends on age and risk factors). Co testing with viral screening is recommended after age 30. Abnormal pap smears and persistnet high risk tests are referred for colposcopy. Colposcopy is a microscopic evaluation of the cervix, often biopsies are taken. Abnormal areas of dysplasis can be obliterated with laser, freezing or excision.
Human Papilloma Virus (HPV) Treatment and Testing
Vaccination should be given BEFORE exposure, usually age 11-12. Two doses required. Gardasil is recommendd for men and women ages 9-26 and for some up to age 45.
88% reduction in virus rate. 90% effective in preventing related cancers. 97% effective in preventing cervical cancer. 100% effective in preventing genital warts
Human Papilloma Virus (HPV) Vaccine
Types 1 and 2. HSV1: cold sores of the mouth, but can be genital. HSV2: genital lesions, but can be oral. No symptoms or periodic localized vesicular rash and skin erosions. Most have no symptoms. Transmitted skin to skin (usually mucosa). Virus usually dormant and non contagious but can shed silently when not dormant. Contagious before, during, and after an outbreak.
Genital Herpes / Herpes Simplex Virus General
Primary infection: first exposure to HSV, can be silent but is often the most painful outbreak with a systemic response (lymphadenopathy, fever, headache, dysuria). Recurrences are less severe. Diagnosed on exam and with viral culture. Serology is inaccurate.
Treatment: No cure. Antiviral meds to improve healing time with each occurence or long term antiviral meds for suppression of recurrences and viral shedding.
Genital Herpes / Herpes Simplex Virus S/S and Treatment
An infection which has spread into uterus and fallopian tubes; can lead to scarring which then can cause infertility or ectopic pregnancy; may require hospitalization and IV antibiotic therapy.
Pelvic Inflammatory Disease (PID)
Retrovirus which attacks T lymphocytes resulting in immunosuppression. Transmitted from contaminated needles, blood transfusion, sexual contact. S/s: flu like illness (fever, diarrhea, wt loss, anemia, lymphadenopathy)
Testing: serum antibody testing, viral load count. Reportable condition.
PrEP: preexposure prophylaxis, for HIV negative individuals at risk, daily antiviral med, expensive
Human Immunodeficiency Virus leading to Acquired Immunodeficiency Syndrome (HIV / AIDS)
Can be transmitted via the placenta to the fetus or through breastmilk. In pregnancy avoid procedures with bleeding potential (amino, FSE, forceps…). Bathe a newborn before giving injections if mother is positive. ART (antiretroviral therapy) orally is given in pregnancy to decrease transmission to baby. Exposed newborns are treated with antiretrovirals as well
Pregnancy Considerations with HIV / AIDS
Transmitted through oral, vaginal, anal, and via placenta routes via damaged skin.
Primary: painless lesion (chancre), may progress to an ulcer, lymphedema
Secondary: skin maculopapular rash involving palms and soles, alopecia
Latent:
Tertiary: 1-30 years later, internal organ damage, blindness, paralysis, dementia.
Diagnosed by serology, always requires secondary testing to confirm a positive case. Treatment: Penicillin G, may require 3 doses.
Syphilis
More US cases of this disease congenitally than congenital HIV. Can cause stillbirth, congential anomalies
Pregnancy Considerations of Syphilis
Toxoplasmosis Other: Hep A & B, syphilis, mumps, parvovirus B19, baricella-zoster Rubella Cytomegalovirus HSV (herpes simplex virus)
TORCH infections: teratogenic
Causes: infections, BV, yeast, poor lubrication/ dryness, lack of arousal, low elasticity from decreased estrogen (menopause), endometriosis, trauma, inflammatory disorders, neurologic disorders, psychosocial causes, stress/relational stress, malignancy, pelvic floor spasm (Vaginismus)
Causes of dyspareunia
unwanted sexual act performed on another person. 1 out of 6 women in US experienced this. History can lead to anxiety, PTSD, depression and suicide. Pelvic exams can be triggering. Women post event need full STI screenings and potential prophylaxis
Sexual assault / sexual violence
Safety and IPV screening every visit. STI screenings: annual chlamydia, gonorrhea, HIV, after sexual assault, with pregnancy. Pap smear q 3 years until age 30, then pap with HPV test every 5 years. Mammogram q-12 years starting between ages 40-50
Screenings for women
Healthy diet, exercise, vaccinations, safe sex education, contraception
Primary prevention in women
Health and violence screenings
Secondary prevention in women
Rehab, physical therapy, therapeutics
Tertiary prevention in women
Menopause management, vitamins, exercise, diet
Age related changes in women
