Women's health Flashcards
Cystitis
Common type a UTI
cystitis refers to inflammation of the urethra and bladder
Symptoms of cystitis
pain, burning or stinging when you pee
needing to pee more often and urgently than normal
urine that’s dark, cloudy or strong smelling
pain low down in your tummy
feeling generally unwell, achy, sick and tired
History taking cystitis? 5
Duration- 5-7 days should be referred because of risk of developing pyelonephritis
Age-unusual in children referral
Presence of fever-referral
Vaginal discharge- referral-not cystitis its a vaginal infection
Location of pain- Pain experienced in the loin area suggests an upper urinary tract infection.
Referral- cystitis-9
Children <16 years Cystitis unusual in this age group
Patients with diabetes More likely to develop complications from a UTI
Duration >7 days-Does not suggest an uncomplicated UTI
Vaginal discharge May indicate vaginitis
Women >70 years More susceptible to complicated UTIs and pyelonephritis; also, symptoms may be indicative of atrophic vaginitis
Pregnancy-Pressure on the urinary tract caused by an infant makes management of UTIs more difficult and can increase the risk of pyelonephritis
Haematuria-Blood may indicate a stone or a tumour
Immunocompromised-More likely to develop complications from a UTI
Patients with associated fever and flank pain-Suggestive of a complicated UTI and/or pyelonephritis
Treatment for cystitis
Analgesics-paracetamol
Antimicrobial therapy, where indicated, is highly effective
Cranberry Juice and D-mannose – Some evidence in prevention of UTIs not for treatment.
Cystitis- advice-7
take paracetamol or ibuprofen
drink plenty of water
hold a hot water bottle on your tummy or between your thighs
avoid having sex
pee frequently
wipe from front to back when you go to the toilet
gently wash around your genitals with a skin-sensitive soap
Thrush
Thrush is a common yeast infection that affects men and women. It’s usually harmless but it can be uncomfortable and keep coming back. It is not classed as a sexually transmitted infection (STI).
Symptoms of thrush
- white vaginal discharge(often like cottage cheese), which does not usually smell
- itching and irritation around the vagina
- soreness and stinging during sex or when you pee
Questions to ask-THRUSH
Discharge-
• Any discharge with a strong odour should be referred.
• Bacterial vaginosis and trichomoniasis are associated with a fishy odour.
• Discharge in bacterial vaginosis tends to be grey-white
• And trichomoniasis greenish-yellow.
• By contrast, discharge associated with thrush is often described as curd like or cottage cheese–like, with little or no odour.
• Note that the physiological discharge is clear and odourless but can cause slight staining of underwear.
Age-
• Thrush can occur in any age group, unlike bacterial vaginosis and trichomoniasis, which are rare in premenarchal girls.
• In addition, trichomoniasis is also rare in women >60 years.
Pruritus-
Vaginal itching tends to be most prominent in thrush compared with bacterial vaginosis and trichomoniasis, where itch is slight or absent.
Onset-
In thrush, the onset of symptoms is sudden, whereas in bacterial vaginosis and trichomoniasis onset tends to be less sudden.
WHEN DO WE REFER
Discharge that has a strong smell- Thrush has no or little odour and therefore this suggests other causes, such as bacterial vaginosis or trichomoniasis Women <16 and >60 years Thrush is unusual in these age groups Patients with diabetes Might suggest poor diabetic control OTC medication failure Patients predisposed to thrush Recurrent attacks Suggests underlying problem or misdiagnosis
Treatment for thrush
Fluconazole (e.g., Canesten thrush oral capsule)
Topical imidazoles (clotrimazole, econazole, miconazole)
Oral
Fluconazole 150mg – single dose
Internal
Pessary – 500mg pessary with applicator –ONCE at night
or
Intravaginal cream – 5g of 10% clotrimazole – ONCE at NIGHT
and/or External cream
2% Clotrimazole cream – Apply 2-3 daily to affected area.
Advise for thrush
Avoid wearing nylon underwear and tights
Do not use vaginal deodorants, foam baths or perfumed soaps
Recurrent symptoms require medical referral
Topical imidazoles can damage latex condoms and diaphragms
Abstain from sexual intercourse until symptoms resolved.
Primary dysmenorrhoea (period pain)
Period pain is common and a normal part of your menstrual cycle. Most women get it at some point in their lives.
Symptoms of primary dysmenorrhoea
SYMPTOMS
• It’s usually felt as painful muscle cramps in the tummy, which can spread to the back and thighs.
- The pain sometimes comes in intense spasms, while at other times it may be dull but more constant.
- It may also vary with each period. Some periods may cause little or no discomfort, while others may be more painful.
- Sometimes you may get pelvic pain even when you do not have your period.
Questions to ask -primary dysmenorrhoea
Age-
PD is most common in adolescents and women in their early 20s.
Secondary dysmenorrhoea usually affects women many years after the menarche, typically after the age of 30 years.
Nature of pain
A great deal of overlap exists between PD and secondary dysmenorrhoea, but generally PD results in cramping, whereas secondary causes are usually described as dull, continuous, diffuse pain
Severity of pain
Pain is rarely severe in PD; the severity decreases with the onset of menses. Any patient presenting with moderate to severe lower abdominal pain should be referred.
Onset of pain
PD starts very shortly before or within 24 hours of the onset of menses and rarely lasts for more than 3 days. Pain associated with secondary dysmenorrhoea typically starts a few days before the onset of menses.
