Management of Female

Reproductive Disorders
Ch 47
 Vulvovaginal infections
Infections very common
Normal vaginal defenses: pH 3.5 4.5
Maintained by normal flora: Lactobacillus
acidophilus
Nsg goal: prevent re-occurrence of
infections
Reduce stress and illness
Maintain normal pH
Avoid introduction of pathogen
 Vaginitis
Inflammation of the vagina
Causes: Candida or Trichomonas
Vaginal discharge
Urethritis may develop due to close
proximity of the urethra
Sx. Redness, burning, ithing, odor, edema
Tx: oral or local medication
 Candidiasis
Fungal or yeast infection Candida albicans
May be present without symptoms
Common in pregnancy, DM and HIV
Also common I patients taking corticosteroids or
oral contraceptives.
Sx: puritis, itching, irritation, white cottage cheese-
like discharge
Tx: anti-fungal agents (Monistat, Terazol,
Mycostatin, Gyne-Lotrimin. Oral: Diflucan
 Bacterial Vaginosis
May occur throughout the menstrual cycle
Discomfort or pain usually not associated
Tx: Flagy B.I.D. (available in vaginal gel)
Patients associated with vaginosis should
be tested for other STDs
 Bacterial Vaginosis
Caused by overgrowth of anaerobic bacteria
amd Gardnerella vaginalis
Fish-like odor; pH > 4.7
Noticeable after sexual intercourse or
during menstruation as a result of an
increased vaginal pH
Risk fx.: douching after menses, smoking
nultiple sex partners, other STDs
 Trichomoniais
Second most common STD
May be transmitted by asymptomatic
carriers.
May be associated with adverse pregnancy
outcomes, PID, cervical neoplasia,
infertility
Vaginal discharge may appear thin, yellow-
green, frothy, malodorous secretion
 Trichomoniais
Causes vaginal irritation, burning, itching
Cervical erythema with multiple small
petechiae (strawberry spots)
pH usually > 4.5
Tx.: treat both partners with Flagyl
 Gerontologic Consideratons
Menopause, decreased estrogen
Dry vaginal mucosa thins & atrophies
Leukorrhea (vaginal discharge)
Itching, burning
Management:
Similar to bacterial vaginosis
Estrogen hormones help restore the epithelium
 Nursing Care
Relieve discomfort sitz baths
Reduce anxiety
Prevent reinfection or spread
Patient education: preventive measures
Abstinence from intercourse
Treatment: antibiotics & iontments
Hygiene practices
Reporting symptoms
 HPV Human Papillomavirus
Sexually transmitted
Various HPV strains
18, 18, 31, 33, 45 result in abnormal pap-smears;
cervical dysplagia, risk for cervical cancer
6, 11 result in condylomata (warts), low risk for
cancer
Prevalent among young sexually active
females
Tx: topical oint. Tichloroacetic acid,
podophyllin (Condylox, Aldara)
 Herpesvirus Type 2
Herpes Genitalis, Herpes Simplex Virus
Herpetic lesions on external genitalia
Tansmittable STD from wet surfaces
Initial outbreak may be painful
Recurrence are less painful, associated with
stress, sunburns, inadequate rest & nutrition,
Complications: spread to buttocks, thighs,
eyes.
 HPV Human Papillomavirus
Tx: Valtrex, Zovirax, Famciclovir
HSV-1 (simplex type 1) causes cold sores
HSV 2 (simplex type 2) genital herpes
Varicell zoster or shingles
Estein-Barr virus
Cytomegalovirus (CMV)
Human B-lymphotorphic virus
Sx: papules, macules, vesicular ulcers, blisters on
vaginal, cervix, perianal. Glans penis, foreskin &
shaft. Flu-like symptoms, malaise, dysuria
Health Problems in Pediatric
Females

Adolescent Reproductive
Health Problems
 Adolescent Pregnancy
Rates of adolescent births still remain high in the U.S.
than other developing countries.
7 out of 10 adolescent mothers complete high school
but are less likely to to to college.
The less familiar an adolescent is with her partner, the
less likely it is that they will use contraception during
intercourse.
Social factors: low socioeconomics, poverty
Maternal success: participation in programs for
pregnant teens, social support systems and a sense of
control over ones life.
 Adolescent Pregnancy
Medical aspects.
Risk for complications exist when there is
a lack of adequate care
Premature labor, low-birth infants, high
neonatal mortality, iron deficiency anemia,
fetopelvic disproportion, prolonged labor.
Infants at risk bacterial infections within
the uterus are associated with early preterm
delivery (<30 wks)