Women's health

Question 1

Cystitis

Answer 1

Common type a UTI

cystitis refers to inflammation of the urethra and bladder

Question 2

Symptoms of cystitis

Answer 2

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

Question 3

History taking cystitis? 5

Answer 3

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.

Question 4

Referral- cystitis-9

Answer 4

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

Question 5

Treatment for cystitis

Answer 5

Analgesics-paracetamol
Antimicrobial therapy, where indicated, is highly effective
Cranberry Juice and D-mannose – Some evidence in prevention of UTIs not for treatment.

Question 6

Cystitis- advice-7

Answer 6

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

Question 7

Thrush

Answer 7

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).

Question 8

Symptoms of thrush

Answer 8

• 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

Question 9

Questions to ask-THRUSH

Answer 9

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.

Question 10

WHEN DO WE REFER

Answer 10

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

Question 11

Treatment for thrush

Answer 11

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.

Question 12

Advise for thrush

Answer 12

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.

Question 13

Primary dysmenorrhoea (period pain)

Answer 13

Period pain is common and a normal part of your menstrual cycle. Most women get it at some point in their lives.

Question 14

Symptoms of primary dysmenorrhoea

Answer 14

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.

Question 15

Questions to ask -primary dysmenorrhoea

Answer 15

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.

Question 16

WHEN DO WE REFER-PD

Answer 16

Heavy or unexplained bleeding
Possibly dysfunctional uterine bleeding
Pain experienced days before menses
Pain that increases at the onset of menses
Women >30 years with new or worsening symptoms
Possibly secondary dysmenorrhoea
Accompanying systemic symptoms, such as fever and malaise
Suggests possible infection or pelvic inflammatory disease
Vaginal bleeding in postmenopausal women
Suggests potentially more sinister cause, such as carcinoma

Question 17

Treatment for PD

Answer 17

Ibuprofen
Take the tablet with or after food
Take one or two tablets three times a day

NAPROXEN
Take two tablets initially followed by one tablet 6-8 hours later
no more that three tablets should be taken in a 24 hour period
NSAIDS
Ibuprofen (200-400mg TDS)
Naproxen 250mg (2 tabs at onset of symptoms followed by 1 tab after 6-8 hrs. Thereafter 1 tab every 6-8 hrs, max 3 tabs/day, max 3 days treatment)
HYOSCINE burylbromide – 2 tabs QDS

Question 18

Advise for PD

Answer 18

stopping smoking – smoking is thought to increase the risk of period pain
• exercise – you may not feel like exercising during a painful period, but being active may reduce pain; try some gentle swimming, walking or cycling
• heat – putting a heat pad or hot water bottle (wrapped in a tea towel) on your tummy may help reduce pain
• warm bath or shower – taking a warm bath or shower can relieve pain and help you relax
• massage – light, circular massage around your lower abdomen may also help reduce pain
• relaxation techniques – relaxing activities, such as yoga or pilates, may help distract you from feelings of pain and discomfort
• transcutaneous electronic nerve stimulation (TENS) – a small battery-operated device that delivers a mild electrical current to your tummy to help reduce pain