c






 

 
  
 




 
 c
   





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c 
c
c


.
The uterus is a hollow organ about the size and shape of a pear. It serves two
important functions: it is the organ of menstruation and during pregnancy it
receives the fertilized ovum, retains and nourishes it until it expels the fetus during
labor.
.
The vagina is the thin in walled muscular tube about 6 inches long leading from the
uterus to the external genitalia. It is located between the bladder and the rectum.
  j  !j".
Each tube is about 4 inches long and extends medially from each ovary to empty into
the superior region of the uterus.
 (2)
The ovaries are for oogenesis-the production of eggs (female sex cells) and for
hormone production (estrogen and progesterone).

j
c 
c

jcc

The external organs of the female reproductive system include the mons pubis, labia
majora, labia minora, vestibule, perineum, and the Bartholin's glands.

j


jc 

Menstruation is the periodic discharge of blood, mucus, and epithelial cells from the
uterus. It usually occurs at monthly intervals throughout the reproductive period,
except during pregnancy and lactation, when it is usually suppressed.
: 
  
  


  

 
 
  
=ysfunctional uterine bleeding (= B) is defined as abnormal uterine bleeding in the absence of organic disease.
It usually presents as heavy menstrual bleeding (menorrhagia).


 j


· cbdominal examination
· Pelvic examination
· Cervical smear
· Infection screening

j


Oirst line: Levonorgestrel-releasing intrauterine system provided long-term use (at least 12 months) is anticipated.
Second line: Tranexamic acid or non-steroidal anti-inflammatory drugs (NScI=s) or combined oral contraceptives
(COCPs).
Third line: Norethisterone (15mg) daily from days 5 to 26 of the menstrual cycle, or injected long-acting
progestogens.

 

· Endometrial ablation
· Hysterectomy
 c
c is a menstrual condition characterized by absent menstrual
periods for more than three monthly menstrual cycles. cmenorrhea may
be classified as primary or secondary.
·   - from the beginning and usually lifelong; menstruation
never begins at puberty.
·    - due to some physical cause and usually of later
onset; a condition in which menstrual periods which were at one time normal
and regular become increasing abnormal and irregular or absent


 j


=iagnosis begins with a gynecologist evaluating a female's medical history

and a complete physical examination including a pelvic examination.

j


· progesterone supplements (hormone treatment)
· oral contraceptives (ovulation inhibitors)
· dietary modifications (to include increased caloric and fat intake)
 
=ysmenorrhea is a menstrual condition characterized by severe and frequent menstrual
cramps and pain associated with menstruation. =ysmenorrhea may be classified as
primary or secondary.
·   - from the beginning and usually lifelong; severe and frequent
menstrual cramping caused by severe and abnormal uterine contractions.
·    - due to some physical cause and usually of later onset; painful
menstrual periods caused by another medical condition present in the body (i.e., pelvic
inflammatory disease, endometriosis).

 


· cramping in the lower abdomen
· pain in the lower abdomen
· low back pain
· pain radiating down the legs
· nausea
· vomiting
· diarrhea
· fatigue
· weakness
· fainting
· headaches

 j

· ultrasound (clso called sonography.)
· magnetic resonance imaging (MRI)
· laparoscopy
· hysteroscopy
j


· prostaglandin inhibitors (i.e., nonsteroidal anti-inflammatory
medications, or NScI=s, such as aspirin, ibuprofen) - to reduce
pain
· acetaminophen
· oral contraceptives (ovulation inhibitors)
· progesterone (hormone treatment)
· dietary modifications (to increase protein and decrease sugar and
caffeine intake)
· vitamin supplements
· regular exercise
· heating pad across the abdomen
· hot bath or shower
· abdominal massage
 

 

   !
" is a combination of physical and emotional
disturbances that occur after a woman ovulates and ends with menstruation.
Common PMS symptoms include depression, irritability, crying, oversensitivity, and
mood swings.

 


· anger and irritability,
· anxiety,
· tension,
· depression,
· crying,
· oversensitivity, and
· exaggerated mood swings


 j


The most helpful diagnostic tool is the menstrual diary, which documents physical
and emotional symptoms over months. There are no laboratory tests to determine
if a woman has PMS.
j


heneral management includes a healthy lifestyle including:

· family and friends can provide emotional support during the

time of a woman's cycle;
· avoid salt before the menstrual period;
· reduce caffeine intake;
· quit smoking;
· exercise;
· reduce alcohol intake; and
· reduce intake of refined sugars

 

c variety of medications are used to treat the different
symptoms of PMS. Medications include diuretics, pain
killers, oral contraceptive pills, drugs that suppress
ovarian function, and antidepressants.
    

 


  
· The nurse should establish rapport with the patient and obtain a health
history, noting the time when symptoms began and their nature and
intensity.
· The nurse then determines whether the onset of symptoms occur before
or shortly after the menstrual flow begins.
· cdditionally, the nurse can show the patient how to develop a chart to
record the timing and intensity of symptoms.
· c nutritional history is elicited to determine if the diet is high in salt,
caffeine, or alcohol or low in essential nutrients.
· Positive coping measures are facilitated. Partners can be advised to assist
by offering support and increased involvement with child care. The patient
can try to plan her working time to accommodate the days she will be less
productive because of the menstrual disorders.
· The nurse encourages exercise, meditation, imagery, and creative
activities to reduce stress.
· The nurse also encourages the patient to take medications as prescribed
and provides instructions about the desired effects of the medications.
    
 

Pelvic inflammatory disease (PI=) is a general term that refers to infection of the
uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the
uterus) and other reproductive organs. It is a common and serious complication of
some sexually transmitted diseases (ST=s), especially chlamydia and gonorrhea.
PI= can damage the fallopian tubes and tissues in and near the uterus and ovaries.

 


PI= goes unrecognized by women and their health care providers about two thirds
of the time. Women who have symptoms of PI= most commonly have lower
abdominal pain. Other signs and symptoms include fever, unusual vaginal
discharge that may have a foul odor, painful intercourse, painful urination,
irregular menstrual bleeding, and pain in the right upper abdomen (rare).


 j

PI= is difficult to diagnose because the symptoms are often subtle and mild. c
pelvic ultrasound is a helpful procedure for diagnosing PI=. cn ultrasound can
view the pelvic area to see whether the fallopian tubes are enlarged or
whether an abscess is present. In some cases, a laparoscopy may be necessary
to confirm the diagnosis. c laparoscopy is a surgical procedure in which a thin,
rigid tube with a lighted end and camera (laparoscope) is inserted through a
small incision in the abdomen. This procedure enables the doctor to view the
internal pelvic organs and to take specimens for laboratory studies, if needed.

j


PI= is usually treated with at least two antibiotics that are effective against a wide
range of infectious agents. These antibiotics can be given by mouth or by injection.
Hospitalization to treat PI= may be recommended if the woman (1) is severely ill
(e.g., nausea, vomiting, and high fever); (2) is pregnant; (3) does not respond to or
cannot take oral medication and needs intravenous antibiotics; (4) has an abscess
in the fallopian tube or ovary (tubo-ovarian abscess); or (5) needs to be monitored
to be sure that her symptoms are not due to another condition that would require
emergency surgery (e.g., appendicitis). If symptoms continue or if an abscess does
not go away, surgery may be needed.
    

 
  
 
 
· The hospitalized patient is maintained on bed rest and is usually
placed in the semi-Oowler͛s position to facilitate dependent
drainage.
· cccurate recording of vital signs and the characteristics and amount
of vaginal discharge is necessary as a guide to therapy.
· The nurse minimizes the transmission of infection to others by
carefully handling perineal pads with gloves, discarding the soiled
pad according to hospital guidelines for disposal of biohazardous
material, and carefully washing hands with a germicidal soap.
· The patient must be informed of the need for precautions and must
be encouraged to take part in procedures to prevent contaminating
others and protecting herself from reinfection.
· Patient teaching consists of explaining how pelvic infections occur,
how they can be controlled and avoided, and their signs and
symptoms.
 
  
  
 
 #
 
    

Cervicitis is an inflammation of the cervixͶthe lower part of the uterus

extending about an inch into the vaginal canal. Most commonly, cervicitis
is the result of an infection, although it can also be caused by injury or
irritation (a reaction to the chemicals in douches and contraceptives, for
example, or a forgotten tampon).

 



· The first symptom of cervicitis is likely to be a vaginal discharge that

becomes more pronounced immediately following your menstrual
period. Other signs include bleeding, itching, or irritation of the
external genitals; pain during intercourse; a burning sensation
during urination; and lower back pain.


 j


· The gynecological exam usually begins with a careful medical

history and a general physical exam.
· Biopsy
· Colposcopy
· Cervicography
· Pelvic exam
· Speculum examination
· Pap smear
· Bimanual (two-handed) examination
This standard gynecological technique enables the doctor to feel any abnormality
in the size, shape, or position of the uterus. If the doctor detects a problem,
it's possible to make a visual inspection of the uterus, ovaries, and other
organs through a minor surgical procedure called laparoscopy

j


· The most common of these procedures are cautery (also known as
heat cautery), cryosurgery (also known as freezing, or cold cautery),
and laser treatment.
   

Cervical polyps are fingerlike growths on the lower part of the

uterus that connects with the vagina (cervix). Cervical polyps
are small, soft, growths that protrude from the mouth of the
cervix.

 


· bleeding after intercourse
· bleeding between periods
· abnormal, heavy bleeding during your menstrual cycle
· bleeding after menopause
· watery, bloody discharge from vagina
· cbnormally heavy periods (menorrhagia)
· cbnormal vaginal bleeding
cfter douching
cfter intercourse
cfter menopause
Between periods
· White or yellow mucus (leukorrhea)

 j

· Cervical polyps can be detected through pelvic exams. Sometimes the doctor may
remove the growth for laboratory testing. =uring a pelvic examination, the health
care provider will see smooth, red or purple, fingerlike growths on the cervix. c
cervical biopsy will show cells that are mildly abnormal and signs of infection.

j


· The health care provider can remove polyps during a simple, outpatient
procedure. hentle twisting of a cervical polyp may remove it, but normally a polyp
is taken out by tying a surgical string around the base and cutting it off. The polyp's
base is removed with electrocautery or a laser.
  
 #

The cervix is the part of the uterus connected to the upper vagina. It is the structure
that dilates during childbirth to allow the baby to traverse the birth canal.
There are two major types of cancer that develop from the cervix.
· Squamous cell cancers arise from the squamous epithelium that covers the visible
part of the cervix.
· cdenocarcinomas arise from the glandular lining of the endocervical canal.

 


· There may be no symptoms of a very early cervical cancer, but
by the time it is large enough to detect visually it is usually
symptomatic with abnormal bleeding. Often this abnormal
bleeding occurs after sexual intercourse.


 j

· The diagnosis of cervical cancer is usually not difficult. It is
usually big enough to be seen and can be biopsied. If it arises
from up inside the cervical canal then it may not be visible.
This will require that a portion of the cervix be removed for
diagnosis. These large biopsies can be accomplished by either
a LEEP or cone procedure.
 


Stage I Cancer confined to the cervix
· Ic Invasive cancer detectable microscopically only
· Ic1 Invasion less than 3 mm and width less than 7 mm
· Ic2 Invasion more than 3 mm but less than 5 mm
· IB cll others, any visible cancer
· IB1 Cervix less than 4 cm in diameter
· IB2 Cervix greater than 4 cm
Stage II Spread to adjacent structures
· IIc Spread onto the vagina
· IIB Spread laterally toward the pelvic wall
Stage III More extensive but still within the pelvis
· IIIc Extends to the lower vagina
· IIIB Extends onto the pelvic wall, obstructed ureter
Stage IV =istant spread or involvement of a pelvic organ
· IVc Involves the inside of the bladder or rectum
· IVB =istant metastases, i.e. lung, liver or bone

j


· In general, cancers of the cervix are treated with radiation. cll other Stage I cancers are
treated either by radical surgery or radical radiation. Some stage IIc cancers can also be
considered for surgery. Otherwise, all stage II, III and IV cancers are treated with radiation.
Occasionally ultra-radical surgery is done on some stage IVc cancers. Surgery for stage IB and
some IIc cancers requires a radical hysterectomy and removal of the pelvic lymph nodes.
Radical hysterectomy means that the cervix is removed by staying as far away from it and the
cancer as possible.
   

 
 

#  
· cll sexually active women may be at risk for Chlamydia, gonorrhea, and
other ST=͛s including HIV, so proper health teachings by the nurse will be
necessary.
· Nurses can assist patients in assessing their own risk. Recognition of risk is
a first step before changes in behavior occur.
· Patients should be discouraged from assuming that a partner is ͞safe͟.
· Nudjudgmental attitudes, educational counseling, and role playing may all
be helpful.
· Nurse has a major role in discussion of sex that is safe as possible.
· Exploring options with patients, determining their use of safer sex
practices and their knowledge deficits, and correcting misinformation may
prevent morbidity and mortality.
· Nurses can educate woman and help them to develop sexual
communication skills and to initiate dialogue about sex with partners.
· Communicating partners about sex, risk, postponing intercourse, and
using safer sex behaviours, including use of condoms, may be lifesaving.
· Nursing care of these patients is complex and requires coordination and
care by experienced health care professionals.
   
 


 



This is infection of the endometrium. It can be divided into pregnancy related

(obstetric) and non-obstetric, acute and chronic.

 


· Oever
· cbdominal pain
· Offensive smelling lochia
· cbnormal vaginal bleeding - postpartum haemorrhage
· cbnormal vaginal discharge
· =yspareunia
· =ysuria
· heneral malaise


· Raised temperature
· Pain and tenderness, which may radiate to the adnexae
· Tachycardia

 j

· Blood cultures are positive in 10-30%
· Check MS
· High vaginal swab for gonorrhoea/Chlamydia
j



· IV clindamycin and gentamicin tds until afebrile for greater than 24
hours. Oral follow up treatment is not required.
· If less systemically unwell, oral combinations of amoxicillin, gentamicin
and metronidazole.
· se doxycycline if chlamydia is suspected.

 


Endometriosis is a condition where tissue similar to the lining of the

uterus (the endometrial stroma and glands, which should only be located
inside the uterus) is found elsewhere in the body.

 


The most common symptom of endometriosis is pelvic pain.
Pain may be felt:
· before/during/after menstruation
· during ovulation
· in the bowel during menstruation
· when passing urine
· during or after sexual intercourse
· in the lower back region
Other symptoms may include:
· diarrhea or constipation (in particular in connection with
menstruation)
· abdominal bloating (again, in connection with menstruation)
· heavy or irregular bleeding
· fatigue
· =iagnostic Tests
· The only reliable way to definitively diagnose endometriosis is by
performing a laparoscopy and to take a biopsy of the tissue. There
are other tests, which the gynaecologist may perform. These
include ultrasound, MRI scans, and gynaecological examinations
j


 $ 
· Pain killers include:
· simple analgesics (ie. aspirin and paracetamol)
· compound analgesics (a combination of either aspirin or
paracetamol)
· mild narcotics (ie. codeine)
· narcotic analgesics (similar to morphine)
· non-steroidal anti-inflammatory drugs (ie. nurofen, ponstan,
voltaren, etc).


Hormonal therapies may include:
· The combined oral contraceptive pill (OC)
· Progestogens | progestins
· Mirena (I =)
· hnRH-analogues (agonists and antagnosists)
· =anazol
· cromatase inhibitors
Surgery
· Laparoscopic surgery is the only definitive way to diagnose
endometriosis.
 c 

*nown as "Endometriosis of the uterus," cdenomyosis is benign and does

not cause cancer. Most commonly, the disease affects the back wall
(posterior side) of the uterus.

 


· cs with Endometriosis, patients with cdenomyosis may
not show any symptoms (asymptommatic). However,
women most commonly experience excessive, heavy or
prolonged menstrual bleeding and painful periods
(dysmenorrhea).


 j

· Pelvic Exam Oindings
· MRI
· Transvaginal ltrasound
· Tissue =iagnosis

 
 

Endometrial cancer refers to several types of malignancy which arise from

the endometrium, or lining of the uterus. The most common subtype,
Ê
Ê

Ê   typically occurs within a few decades of
menopause, is associated with excessive estrogen exposure, often
develops in the setting of endometrial hyperplasia, and presents most
often with vaginal bleeding.

  

· cbnormal uterine bleeding, abnormal menstrual periods
· Bleeding between normal periods in premenopausal women
· Vaginal bleeding and/or spotting in postmenopausal women


 j

· c Pap smear may be either normal or show abnormal cellular changes.
· Endometrial curettage is the traditional diagnostic method. Both endometrial
and endocervical material should be sampled.
· If endometrial curettage does not yield sufficient diagnostic material, a
dilation and curettage (=
C) is necessary for diagnosing the cancer.
· Endometrial biopsy or aspiration may assist the diagnosis.
· Transvaginal ultrasound to evaluate the endometrial thickness in women with
postmenopausal bleeding is increasingly being used to evaluate for
endometrial cancer.
· Recently, a new method of testing has been introduced called the TruTest,
offered through hynecor. It uses the small flexible Tao Brush to brush the
entire lining of the uterus. This method is less painful than a pipelle biopsy and
has a larger likelihood of procuring enough tissue for testing. Since it is simpler
and less invasive, the TruTest can be performed as often, and at the same time
as, a routine Pap smear, thus allowing for early detection and treatment.
· Ongoing research suggests that serum p53 antibody may hold value in
identifying high-risk endometrial cancer.



Endometrial carcinoma is surgically staged using the OIhO cancer staging system
Stage Ic: Tumor is limited at the endometrium
Stage IB: Invasion of less than half the myometrium
Stage IC: Invasion of more than half the myometrium
Stage IIc: Endocervical grandular involvement only
Stage IIB: Cervical stromal invasion
Stage IIIc: Tumor invades serosa/adnexa, or malignant peritoneal cytology
Stage IIIB: vaginal metastasis
Stage IIIC: metastasis to pelvic / aortic lymph nodes
Stage IVc: invasion of the bladder / bowel
Stage IVB: distant metastasis, including intraabdominal / inguinal lymph nodes

j


· Surgical treatment should consist of, at least, cytologic sampling of the
peritoneal fluid, abdominal exploration, palpation and biopsy of suspicious
lymph nodes, abdominal hysterectomy, and removal of both ovaries (bilateral
salpingo-oophorectomy).
· Chemotherapy may be considered in some cases, especially for those with
stage 3 and 4 disease.
· Hormonal therapy with progestins and antiestrogens has been used for the
treatment of endometrial stromal sarcomas.
 

c leiomyoma (plural is 'leiomyomata') is a benign smooth muscle

neoplasm that is not premalignant. They can occur in any organ, but the
most common forms occur in the uterus, small bowel and the esophagus.

 


· Important symptoms include abnormal gynecologic hemorrhage, heavy or painful
periods, abdominal discomfort or bloating, back ache, urinary frequency or retention,
and in some cases, infertility. There may also be pain during intercourse, depending on
the location of the fibroid. =uring pregnancy they may be the cause of miscarriage,
bleeding, premature labor, or interference with the position of the fetus.


 j


· =iagnosis is usually accomplished by bimanual examination, better yet by

gynecologic ultrasonography, commonly known as "ultrasound."
· Sonography will depict the fibroids as focal masses with a heterogeneous texture,
which usually cause shadowing of the ultrasound beam.
· In cases where a more precise assay of the fibroid burden of the uterus is needed,
also magnetic resonance imaging (MRI) can be used to definite the depiction of the
size and location of the fibroids within the uterus.

j


Surgery:
· Surgical removal of a uterine fibroid usually takes place via hysterectomy, in which the
entire uterus is removed, or myomectomy, in which only the fibroid is removed.
· Medical therapy
·
· Oirst line treatment may involve oral contraceptive pills, either combination pills or
progestin-only, in an effort to manage symptoms.
    

 
 
  

· Nurses should explain the various diagnostic

procedures to help alleviate the patient͛s anxiety.
· The nurse͛s role in patient education is to dispel
myths and encourage the patient to seek care if
problems occur.
· The patient is encouraged to share her concerns and
to assume increasing responsibility for her own care.
She is encouraged and assisted in learning to care for
whatever physical problems may occur.
   
%  
  j
 


cn ovarian cyst is any collection of fluid, surrounded by a

very thin wall, within an ovary.
„
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j


· pain relievers, including nonsteroidal anti-inflammatory drugs such as
ibuprofen (Motrin, cdvil), acetaminophen (Tylenol), or narcotic pain
medicine (by prescription) may help reduce pelvic pain.
· NScI=s usually work best when taken at the first signs of the pain.
· a warm bath, or heating pad, or hot water bottle applied to the lower
abdomen near the ovaries can relax tense muscles and relieve cramping,
lessen discomfort, and stimulate circulation and healing in the ovaries.
Bags of ice covered with towels can be used alternately as cold treatments
to increase local circulation.
· chamomile herbal tea (Matricaria recutita) can reduce ovarian cyst pain
and soothe tense muscles.
· urinating as soon as the urge presents itself.
· avoiding constipation, which does not cause ovarian cysts but may further
increase pelvic discomfort.
· in diet, eliminating caffeine and alcohol, reducing sugars, increasing foods
rich in vitamin c and carotenoids (e.g., carrots, tomatoes, and salad
greens) and B vitamins (e.g., whole grains).
· combined methods of hormonal contraception such as the combined oral
contraceptive pill -- the hormones in the pills may regulate the menstrual
cycle, prevent the formation of follicles that can turn into cysts, and
possibly shrink an existing cyst.
· clso, limiting strenuous activity may reduce the risk of cyst rupture or
torsion.
 %  
 
j

One of a number of benign neoplasms of the ovary that does

not invade tissue or metastasize. May take the form of a solid
tumor or fluid-filled cyst.

 


Most functional cysts and benign tumors are asymptomatic.


 j


· c pregnancy test is done to exclude ectopic pregnancy.

· Transvaginal ultrasonography can usually confirm the diagnosis.
· If results are indeterminate, MRI or CT may help.

j


· Most ovarian cysts < 8 cm resolve without treatment; serial

ultrasonography is done to document resolution. Cyst removal (ovarian
cystectomy) via laparoscopy or laparotomy may be necessary for cysts ш 8
cm, cysts that persist for > 3 menstrual cycles, and hemorrhagic corpus
luteum cysts with peritonitis. Cystic teratomas require removal via
cystectomy if possible. Oophorectomy is done for fibromas,
cystadenomas, cystic teratomas > 10 cm, and cysts that cannot be
surgically removed separately from the ovary.
  

Ovarian cancer is cancer that starts in the ovaries. The ovaries

are the female reproductive organs that produce eggs.

 


· Sense of pelvic heaviness
· Vague lower abdominal discomfort
· Vaginal bleeding
· Weight gain or loss
· cbnormal menstrual cycles
· nexplained back pain that worsens over time
· Increased abdominal girth
· Non-specific gastrointestinal symptoms:
p Increased gas
p Indigestion
p Lack of appetite
p Nausea and vomiting
p Inability to ingest usual volumes of food
p Bloating

   
· Stage I. Ovarian cancer is confined to one or both ovaries.
· Stage II. Ovarian cancer has spread to other locations in the pelvis such as the
uterus or fallopian tubes.
· Stage III. Ovarian cancer has spread to the lining of the abdomen (peritoneum) or
to the lymph nodes within the abdomen. This is the most common stage of
disease identified at the time of diagnosis.
· Stage IV4 Ovarian cancer has spread to organs beyond the abdomen.

 j

· c physical examination may reveal increased abdominal girth and ascites (fluid within
the abdominal cavity).
· Tests include:
· CBC
· Blood chemistry
· Cc125 - is a protein made by your body in response to many different conditions. Many
women with ovarian cancer have abnormally high levels of Cc 125 in their blood.
However, a number of noncancerous conditions also cause elevated Cc 125 levels, and
many women with early-stage ovarian cancer have normal Cc 125 levels. Because of this
lack of specificity, the Cc 125 test isn't used for routine screening in average-risk women
and is of uncertain benefit in high-risk women
· Quantitative serum HCh (blood pregnancy test)
· clpha fetoprotein
· rinalysis
· hI series
· Exploratory laparotomy
· ltrasound
· cbdominal CT scan or MRI of abdomen

j


· Surgery is the preferred treatment and is often needed to diagnose ovarian cancer.
· Studies have shown that surgery performed by a specialist in gynecologic oncology
results in a higher cure rate.
· Chemotherapy is used as after surgery to treat any remaining disease. Chemotherapy
can also be used if the cancer comes back.
· Radiation therapy is rarely used in ovarian cancer in the nited States.
    

 
   
· Nursing measures include those related to the patient͛s various treatment plan, be it surgery,
radiation, chemotherapy, or palliation. Emotional support, comfort measures and
information, plus attentiveness and caring, are meaningful aids to this patient and her family.
· Patients with advanced ovarian cancer may develop ascites and pleural effusion. Nursing care
may include administering intravenous therapy to alleviate fluid and electrolyte imbalances,
intitiating total parenteral nutrition to provide adequate nutrition, providing postoperative
cre after intestinal bypass to alleviate an obstruction, and providing pain relief and managing
drainage tubes.
· cll sexually active women may be at risk for Chlamydia, gonorrhea, and other ST=͛s including
HIV, so proper health teachings by the nurse will be necessary.
· Nurses can assist patients in assessing their own risk. Recognition of risk is a first step before
changes in behavior occur.
· Patients should be discouraged from assuming that a partner is ͞safe͟.
· Nudjudgmental attitudes, educational counseling, and role playing may all be helpful.
· Nurse has a major role in discussion of sex that is safe as possible.
· Exploring options with patients, determining their use of safer sex practices and their
knowledge deficits, and correcting misinformation may prevent morbidity and mortality.
· Nurses can educate woman and help them to develop sexual communication skills and to
initiate dialogue about sex with partners.
· Communicating partners about sex, risk, postponing intercourse, and using safer sex
behaviours, including use of condoms, may be lifesaving.
· Nursing care of these patients is complex and requires coordination and care by experienced
health care professionals.
   



Vaginitis is a term for any infection or inflammation

of the vagina.

 



· In general, vaginitis may cause itching, irritation, or

abnormal vaginal discharge.

j



· ¢east infections are usually treated with an anti-yeast

cream or suppository placed inside the vagina.
· Bacterial vaginosis is treated with an antibiotic that
gets rid of the "bad" bacteria and leaves the "good"
bacteria.
· Non-infectious vaginitis can be treated by stopping the
use of the product that caused the allergic reaction or
irritation.

 


· The symptoms of vaginal cancer include unusual bleeding (particularly after
sex, between periods or after the menopause), increased or unusual discharge
from the vagina, and discomfort or pain in the pelvic area. p to one in ten
women have a lump or growth that can be felt in the vagina, and some may
have a persistent vaginal itch.
j


· Surgery, radiation therapy and chemotherapy are the most common
treatments.
Surgery options include:
p Laser surgery. c narrow beam of light is used to kill very early stage cancer
cells
p Wide local excision. The surgeon takes out the cancer and some of the
surrounding tissue.
p Vaginectomy. The surgeon removes the vagina and maybe lymph nodes
from the pelvic area.
p Radical hysterectomy. If cancer has spread outside of the vagina, the
uterus, ovaries and fallopian tubes, as well as lymph nodes may be
removed.
· Radiation therapy (also called radiotherapy) is the use of high-energy rays to
kill cancer cells.
· Chemotherapy is the use of drugs to kill cancer cells.

 j

· Pelvic Exam: The doctor feels the uterus, vagina,
ovaries, fallopian tubes, bladder and rectum for
any abnormalities.
· Pap test: The doctor gently scrapes the outside of
the cervix and vagina and takes sample cells for
testing.
· Colposcopy: The doctor inserts an instrument with
binocular magnifying lenses into the vagina and
checks the vaginal walls and cervix.
· Biopsy: The doctor takes out a small piece of
vaginal tissue to send to the laboratory. ct the
laboratory, a pathologist will look at the tissue
under a microscope to determine whether the
cells are cancer.
   

 
 
 
· Nursing measures include those related to the patient͛s
various treatment plan, be it surgery, radiation,
chemotherapy, or palliation. Emotional support, comfort
measures and information, plus attentiveness and caring,
are meaningful aids to this patient and her family.
· Patients with advanced ovarian cancer may develop
ascites and pleural effusion. Nursing care may include
administering intravenous therapy to alleviate fluid and
electrolyte imbalances, intitiating total parenteral
nutrition to provide adequate nutrition, providing
postoperative cre after intestinal bypass to alleviate an
obstruction, and providing pain relief and managing
drainage tubes.
 4    
 
    

 


Vulvitis is simply an inflammation of the vulva, the soft folds of skin

outside the vagina.

 


· redness and swelling on the labia and other parts of the vulva
· excruciating itching
· clear, fluid-filled blisters (present when the vulva is particularly
irritated)
· sore, scaly, thickened, or whitish patches (more prevalent in
chronic vulvitis) on the vulva


 j

· blood tests
· urinalysis
· tests for sexually transmitted diseases (ST=s)
· Pap test
· j


· self-help measures (i.e., avoiding external irritants known to
provoke vulvitis)
· sitz baths with soothing compounds (to help control the itching)
· hydrocortisone creams
   


Oolliculitis is an infection in a hair follicle, which is an

opening in the skin that contains the hair root.

 


· Oolliculitis looks like a small, pus-filled pimple, usually around
the base of a hair. Pus seeping from this pustule can be tinged
with blood. . In some cases, folliculitis can result in a painful skin
abscess called a boil. c boil is a pocket below the skin͛s surface
that contains pus and feels warm to the touch. It is rare,
however, for folliculitis to cause a serious skin infection.

j


· Bacterial folliculitis infections are usually mild and can be
cleared up by applying an over-the-counter topical antibiotic
cream or ointment to the affected area as directed by your
doctor. If the infection covers a large area or multiple areas,
your doctor may prescribe an oral antibiotic. If you have
repeated occurrences of folliculitis, your doctor may
recommend bathing with an antibacterial soap. If the folliculitis
is caused by a fungal infection, your doctor will prescribe
antifungal drugs and topical treatments.
 %
 &   
 c 

Bartholin's gland cyst is a swollen fluid-filled lump that develops

from a blockage of one of the Bartholin's glands, which are
small glands located on each side of the opening to the
vagina.

 


· pain that occurs with walking, sitting, physical activity, or sexual
intercourse
· fever and chills
· increased swelling in the vulva area over a two- to four-day period
· drainage from the cyst, normally occurring four to five days after the
swelling starts


 j

· c Bartholin's gland cyst or abscess is diagnosed by a gynecological
pelvic exam. If the cyst appears to be infected, a culture is often
performed to identify the type of bacteria causing the abscess.

j


· If the cyst is not infected, treatment options include:
· watchful waiting by the woman and her health care professional
· soaking of the genital area with warm towel compresses
· soaking of the genital area in a sitz bath
· use of non-prescription pain medication to relieve mild discomfort
If the Bartholin's gland is infected, there are several
treatments available to treat the abscess, including:

· soaking of the genital area in a sitz bath

· treatment with antibiotics
· use of prescription or non-prescription pain medication
· incision and drainage, i.e., cutting into the cyst and draining the
fluid (not usually successful, as the cyst often reoccurs)
· placement of a drain (Word catheter) in the cyst for two to four
weeks so fluid can drain and prevent reoccurrence of the cyst
· marsupialization
· window operation
· use of a carbon dioxide laser to open the cyst and heat the cyst
wall tissue so that the cyst cannot form a sac and reoccur
· incision and drainage, followed by treatment with silver nitrate
to burn the cyst wall so the cyst cannot form a sac and reoccur
· removal of the entire Bartholin's gland cyst, if the cyst has
reoccurred several times after use of other treatment methods

  

Epidermal cysts are also known as epithelial or infundibular cysts

and present as intradermmal or subcutaneous tumours that grow
slowly and occur on the face, neck, back and scrotum.

 


· Most often they are a painless lump
· They may present with discharge of a foul cheese-like material
· If they become infected they are red, inflamed and painful
· Lesions of the genitals can be painful during intercourse and cause problems with
walking or wearing underwear. They can also interfere with micturition.
· Sebaceous or epidermoid cysts appear as firm, round, mobile, flesh-coloured to yellow
or white subcutaneous nodules of variable size.
· c central pore or punctum may tether the cyst to the overlying epidermis and a thick
cheesy material can sometimes be expressed.
· In people with dark skin, the cysts may also be pigmented.

j


· If a cyst is uncomplicated then masterly inactivity should be advised. Tell the patient that
the cyst will probably disappear spontaneously leaving no trace but even the most skilful
excision will leave a permanent scar. cs always, should the situation change the patient
may return.
· If the cyst is red and hot it is probably infected. Olucloxacillin or another antibiotic
effective against staphylococci should be chosen. The contents of a cyst smell foul, even
if not infected. Infection may be mixed and in lesions of the scalp and ano-genital area
anaerobic flora are more likely.
· If the cyst has ruptured the foul contents can be expressed. This should be done but the
cyst may well re-form.
· If the cyst is troublesome or if the patient, after counselling, is eager to have it removed,
then it may be excised as a surgical procedure under the Ê
 Ê
Ê Êof minor
surgery. There is no place for simple incision as the cyst will re-form. The entire cyst wall
must be removed.
 

Nevi are not uncommon on the vulva, and can have a

variety of color schemes, ranging from brown,
brown-black, black, flesh-colored, or red.

 


Melanocytic nevi appear as small, circumscribed, variably pigmented macules or raised
papules that may be congenital or acquired.
Some authors have suggested that nevi occurring on the vulva are more likely to
undergo malignant transformation; therefore, careful examination is recommended.


 j

· Vulvar biopsy is a surprisingly easy office-based technique. Colposcopy of the vulva with
acetic acid application, which can be challenging, will often help locate the optimum
biopsy site. One should consider performing a biopsy for any of the following vulvar
lesions:
· Vulvar Biopsy
·
· cny enlarging vulva lesion or one that has changed color or appearance.
· Lesions those are raised or pigmented.
· Presumed BPV unresponsive to office treatments.
· Vulvar dermatoses where the diagnosis is in doubt or there is no response to treatment.
· cny lesion that appears malignant.
· cny lesion that has associated white or thickened areas

j


· No treatment is needed
   


Vulvar dystrophy is a degeneration of the vulvar tissue. It occurs in

women who are past menopause.

 



· The most common symptoms of vulvar dystrophy are:

· dry, reddened areas in the vulva
· itchy vulva
· white or thickened areas of the vulva
· shiny skin around the vulva
· pain during sex
· Shrinkage of the labia and vaginal opening.


 j

· ¢our doctor will take a biopsy of the vulvar tissue to rule out cancer. The doctor will also
check for signs of infection.

j


· Vulvar dystrophy can be treated . The treatment will depend on the source of the
problem. ¢our doctor may prescribe creams that will relieve your symptoms.
· The doctor may also suggest the following:
· keep the area dry
· wear lose clothing and
· stop using vaginal sprays
· do not use perfumed soaps
· do not use perfumed laundry detergent or fabric softener
· do not use tampons or scented toilet paper
   

Women with vulvodynia have chronic vulvar pain with no

known cause. ntil recently, doctors didn͛t recognize this as a
real pain syndrome.
j  
    
· heneralized vulvodynia ispain in different areas of the vulva at
different times. Vulvar pain may be constant or occur every once in
a while. Touch or pressure may or may not prompt it. But this may
make the pain worse.
· Vulvar vestibulitis syndrome is pain in the vestibule. This is the
entrance to the vagina. Often a burning sensation, this type of
vulvar pain comes on only after touch or pressure, such as during
intercourse.

 


· Burning, stinging, or rawness
· cching, soreness, or throbbing
· Itching

j


clthough there is no cure, self-care and treatments for vulvodynia
can help bring relief. Women with vulvodynia need to see what
works best for them because this varies from individual to
individual.
 

· Local anesthetics, such as lidocaine
· Topical estrogen creams
· Tricyclic antidepressants
· cnticonvulsants
· Nerve blocks
· Interferon injections

j
· Physical therapy, which involves exercise to strengthen pelvic
muscles and lessen muscle spasms
· Biofeedback, which helps you learn to relax vaginal muscles to
lessen pain


· If you have a type of vulvodynia called vulvar vestibulitis
syndrome, your doctor may suggest surgery to remove painful
tissue, especially if other options have not brought relief.
  
  

Cancer of the vulva is rare: each year just over 1000

women in the * are diagnosed with it. Research is
going on all the time into the cause of vulval cancer.

 



· The most common symptoms of cancer of the vulva are:

· itching, burning and soreness of the vulva
· a lump, swelling or wart-like growth
· thickened, raised, red, white or dark patches on the skin of the vulva
· bleeding or a blood-stained vaginal discharge
· burning pain when passing urine
· pain in the area of the vulva
· a sore or ulcerated area on the vulva
· a mole on the vulva that changes shape or colour.



#
· Blood test
· Chest x-ray
· CT (CcT) scan
· Magnetic resonance imaging (MRI scan)
· Examination under anaesthetic (E c)


   



·

 '    
 This is very early cancer (some doctors describe it as pre-
cancer). The cancer is found in the vulva only and is only in the surface of the skin.
·

 ( Cancer is found only in the vulva and/or the space between the opening of the
rectum and the vagina (perineum).The affected area is 2 cm (about 1 inch), or less, wide.
·

 ) Cancer is found in the vulva and/or the perineum. The affected area is larger than 2
cm (1 inch).
·

 * Cancer is found in the vulva and/or perineum and has spread to nearby tissues such
as the lower part of the urethra (the tube through which urine passes), the vagina, the anus
(the opening of the rectum) and/or nearby lymph nodes.
·

 + The cancer has spread beyond the urethra, vagina and anus into the lining of the
bladder or the bowel; or, it may have spread to the lymph nodes in the pelvis or to other
parts of the body.

 
There are three grades; grade 1 (low-grade), grade 2 (moderate-grade) and grade 3 (high-grade).
· ,  means that the cancer cells look very much like the normal cells of the vulva. They
usually grow slowly and are less likely to spread.
·  
,  means the cells look more abnormal than low-grade cells but not as
abnormal as high-grade cells.
· ,  means the cells look very
j


· Surgery is the main treatment for cancer of the

vulva.
· Radiotherapy may sometimes be given to shrink
the cancer before surgery. It can also be given
after surgery to make sure any remaining cells are
destroyed, or it can be used instead of surgery.
· Often radiotherapy and chemotherapy can be
used together (chemoradiation) to make them
more effective.
    

 
  
 
· The woman with vulvovaginal symptoms should be examined as soon as
possible after onset of symptoms. She is instructed not to douche because
doing so removes the vaginal discharge needed to make the diagnosis.
· The major goal for a nurse for the patient include relief of pain and
discomfort; reduction of anxiety related to stress symptoms; prevention of
reinfection or infection of sexual partner; and acquisition of knowledge
about methods for preventing vulvovaginal infections and managing self-
care.
· The nurse may need to reinforce instructions for warm perineal irrigations
that can provide comfort and also clean the infected area if indicated.
Irrigations may be recommended after urination or defecation.
· Nurses must discuss ways to help prevent vulvovaginal infections in a way
it may help the patient to adopt specific strategies to decrease infection
and the related symptoms.
· The nurse should also stress the importance of hand washing before and
after each administration of medication especially topical creams and
suppositories.
· The key to nursing responsibilities for patients with vulvar dystrophies
focus on teaching. Important topics include hygiene and self-monitoring
for signs and symptoms of complications.
 %
c
j 



 
 c

  

 %

  

halactorrhea is the secretion of breast milk in men, or in women who are
not breastfeeding an infant. halactorrhea (say: "gal-act-tor-ee-ah") is a
condition that occurs when a woman's breast makes milk (or a milky
discharge) even though she is not breast feeding a baby.

 



· Milky discharge from one of both nipples (discharge may also be yellow or
greenish in color)
· cn absence of menstrual periods or periods that are not regular
· Headaches
· Vision loss
· Less interest in sex
· Increase in hair growth on your chin or chest
· ccne
· Erectile dysfunction and less interest in sex in men

 j

· c physical examination, along with a breast examination, will usually be
conducted.
· Blood and urine samples may be taken to determine levels of various hormones in
the body, including prolactin and compounds related to thyroid function.
· c mammogram (an x ray of the breast) or an ultrasound scan (using high frequency
sound waves) might be used to determine if there are any tumors or cysts present
in the breasts themselves.
· If a tumor of the pituitary gland is suspected, a series of computer assisted x rays
called a computed tomography scan (CT scan) may be done.
· cnother procedure that may be useful is a magnetic resonance imaging (MRI) scan
to locate tumors or abnormalities in tissues.

j


· The drug bromocriptine is often prescribed first to reduce the secretion of
prolactin and to decrease the size of pituitary tumors. This drug will control
galactorrhea symptoms and in many cases may be the only therapy necessary.
· Oral estrogen and progestins (hormone pills, like birth control pills) may control
symptoms of galactorrhea for some women.
· Surgery to remove a tumor may be required for patients who have more serious
symptoms of headache and vision loss, or if the tumor shows signs of enlargement
despite drug treatment.
· Radiation therapy has also been used to reduce tumor size when surgery is not
possible or not totally successful. c combination of drug, surgery, and radiation
treatment can also be used.
 



Mastitis is a condition that causes the breast tissue to

become inflamed. It usually occurs in women who
are breastfeeding, so it is often referred to as
lactation mastitis.

 



Symptoms of mastitis include:

· the appearance of a red area on part of your breast that

may feel hot and painful to touch,
· the breast can then start to appear lumpy and red, and
· a burning pain in the breast, that may be continuous or
only occur when you are breastfeeding.
· Some women will also experience flu-like symptoms such
as:
· aches,
· fever,
· shivering and chills,
· feeling tired,
· feeling anxious or stressed, and
· a general sense of feeling unwell.

 j

· ¢our hP should be able to make a confident diagnosis of mastitis based on
a physical examination and by asking you about your symptoms.
· If your symptoms are particularly severe, or do not respond to treatment,
your hP may take a small sample of your breast milk for further testing.

j


· cntibiotics are usually prescribed by a physician to help clear up the
infection. Women with mastitis should schedule an appointment with a
doctor.
· se warm water on the infected area of the breast before breast-feeding
to help stimulate let-down (the milk ejection reflex).
· Breast-feed or pump frequently, using both breasts. Lactation consultants
recommend first breast-feeding from the unaffected breast until let-down
(milk ejection reflex) occurs and then switch to the breast with mastitis.
· Breast-feed only until the breast is soft.
· cpply icy compresses to the breasts after breast-feeding to relieve pain
and swelling.
· =rink fluids and get enough rest.
· csk a physician about whether over the counter pain relievers such as
acetaminophen (Tylenol) or ibuprofen are safe to reduce pain
 
   !


"
This is a benign breast disease that can mimic invasive
carcinoma clinically. The process that causes the condition
are still being debated, but histologically it is characterised
by dilation of major ducts in the subareolar region.

 



· The condition may present in one of several ways:

· Microcalcification on a routine mammogram (most
common)
· Nipple discharge - often blood stained
· c palpable subareolar mass
· Non-cyclical mastalgia
· Nipple inversion or retraction

 j

· Mammogram
· ltrasound
· halactography
· =uctal lavage and cytology

j


=espite advances in investigative techniques, the
incidence of false negatives remain high. Excision of
the duct remains the only reliable method of
establishing the diagnosis and is also useful in
alleviating the symptom of persistent nipple
discharge. Image-guided surgery via ductal endoscopy
is a promising development.
      
 
  

Oibroadenoma of the breast is a benign (noncancerous)

tumor.

 


· Lumps may be:
· Oirm
· Moveable
· Painless
· Rubbery

 j

Biopsy (needle or open)
Breast ultrasound
Oine needle aspiration
Mammogram
Physical examination

j


· The lump may be surgically removed at the time of an open biopsy
(this is called an excisional biopsy). The decision depends on the
features of the lump and the patient's preferences.
· clternative treatments include removing the lump with a needle and
destroying the lump without removing it (such as by freezing, in a
process called cryoablation).
  
 

Oibrocystic breast disease is described as common, benign (non-cancerous)

changes in the tissues of the breast. The term "disease" in this case is
misleading, and many providers prefer the term "change."

 


· c dense, irregular and bumpy "cobblestone" consistency in the
breast tissue
· sually more marked in the outer upper quadrants
· Breast discomfort that is persistent, or that occurs off and on
(intermittent)
· Breast(s) feel full
· =ull, heavy pain and tenderness
· Premenstrual tenderness and swelling
· Breast discomfort improves after each menstrual period
· Nipple sensation changes, itching



#
· Mammography may be difficult to interpret due to dense tissue.
· c biopsy of the breast may be necessary to rule out other disorders.
· cspiration of the breast with a fine needle can often diagnose and
treat larger cysts .
j


· Self care may include restricting dietary fat to
approximately 25% of the total daily calorie intake,
and eliminating caffeine.
· Performing a breast self-examination monthly, and
wearing a well-fitting bra to provide good breast
support are important.
· The effectiveness of Vitamin E , Vitamin B-6 , and
herbal preparations, such as evening primrose oil
are somewhat controversial. =iscuss their use with
your health care provider.
· Oral contraceptives may be prescribed because
they often decrease the symptoms. c synthetic
androgen may be prescribed by a doctor in severe
cases, when the potential benefit is thought to
outweigh the potential adverse effects.
 %


Breast cancer is a cancer that starts in the cells of the breast in

men and women. Worldwide, breast cancer is the second
most common type of cancer after lung cancer (10.4% of all
cancer incidence, both sexes counted and the fifth most
common cause of cancer death.
„

  

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 mm
  
· Nx - regional lymph nodes cannot be assessed. Perhaps due to previous removal.
· N0 - no regional lymph node metastasis.
· N1 - metastasis to movable regional axillary lymph nodes on the same side as the
affected breast.
· N2 - metastasis to fixed regional axillary lymph nodes, or metastasis to the internal
mammary lymph nodes, on the same side as the affected breast.
· N3 - metastasis to supraclavicular lymph nodes or infraclavicular lymph nodes or
metastasis to the internal mammary lymph nodes with metastasis to the axillary lymph
nodes.

  

· Indications of breast cancer other than a lump may include changes in breast size or
shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge. Pain is an
unreliable tool in determining the presence of breast cancer, but may be indicative of
other breast-related health issues such as mastodynia.
.
 j

· Breast cancer screening is an attempt to find unsuspected cancers. The most common
screening methods are self and clinical breast exams, x-ray mammography, and breast
Magnetic resonance imaging (MRI).
j


· The mainstay of breast cancer treatment is surgery when the tumor is localized, with
possible adjuvant hormonal therapy (with tamoxifen or an aromatase inhibitor),
chemotherapy, and/or radiotherapy. ct present, the treatment recommendations after
surgery (adjuvant therapy) follow a pattern. Treatment possibilities include radiation
therapy, chemotherapy, hormone therapy, and immune therapy.
   

 
 %
 
· The nurse may recommend that the patient wear a supportive bra both day and
night for a week except during bathing, decrease salt and caffeine intake, and take
ibuprofen (Motrin) as needed for its anti-inflammatory actions.
· The major goals for the patient may include increased knowledge about the
disease and its treatment; reduction of preoperative and postoperative fears,
anxiety and emotionsal stress; improvement of decision-making ability; pain
management; maintenance of skin integrity; improved self-concept; improved
sexual function; and the absence of complications.
· The nurse caring for the woman who has just received a diagnosis of breast cancer
needs to be knowledgeable about a current treatment options and able to discuss
tehm with the patient.
· The nurse should be aware of the information that has been given to the patient
by the physician to answer specific questions the patient may have.
· cs appropriate, the nurse discusses uses of medications, the extent of treatment,
management of side effects, possible reactions after treatment, frequency and
duration of treatment and treatment goals with the patient.
· The nurse must provide anticipatory teaching and counseling at each stage of the
process and identifies sensations that can be expected during additional diagnostic
procedures.
· The nurse also discusses the implications of each treatment option and how it may
affect various aspects of the patient͛s treatment course and lifestyle.
· Careful guidance and supportive counseling are the interventions the nurse can
use to help such a patient.
c

 


  


    




 
 c
 

  



 j
c

j


j

The male reproductive tract consists of external genitals and internal organs. The primary function of the
male's reproduction system is to produce male sex cells, which are called sperm cells. The primary organs
of the male's reproduction system are the two testes in which the sperm cells are formed. The other
structures are the duct system and the accessory glandular structure.
 
 :j 
j






  





· Prostatitis is a frequently painful condition that affects mostly young
and middle-aged men. =octors may have difficulty diagnosing
prostatitis because the symptoms are not the same for every patient,
and many of the symptoms - such as painful or burning urination and
incomplete emptying of the bladder - could be signs of another
disease.

 


· chills;
· fever;
· pain in the lower back and genital area;
· urinary frequency and urgency, often at night;
· burning or painful urination; body aches; and
· a demonstrable infection of the urinary tract as evidenced by white
blood cells and bacteria in the urine.

 j

· c doctor performs a digital rectal exam (=RE) by inserting a gloved and
lubricated finger into the patient͛s rectum, just behind the prostate.
· The doctor can diagnose the bacterial forms of prostatitis by examining a
urine sample with a microscope.
· To confirm the prostate infection, the doctor may obtain two urine
samplesͶbefore and after prostate massage.
· Since many different conditions must be considered, the doctor may order
a full range of tests, including ultrasound or magnetic resonance imaging
(MRI), biopsy, blood tests, and tests of bladder function.
j


· ccute prostatitis may require a short hospital stay so that fluids and
antimicrobials can be given through an intravenous, or IV, tube.
· Chronic bacterial prostatitis requires a longer course of therapy. The
doctor may prescribe a low dose of antimicrobials for 6 months to prevent
recurrent infection.
· No treatment is needed for asymptomatic inflammatory prostatitis
     
% 

  

It is common for the prostate gland to become enlarged as a man ages.

=octors call this condition benign prostatic hyperplasia (BPH), or benign
prostatic hypertrophy.
Normal urine flow. rine flow with BPH.

 


· Many symptoms of BPH stem from obstruction of the urethra and gradual loss of bladder function,
which results in incomplete emptying of the bladder. The symptoms of BPH vary, but the most
common ones involve changes or problems with urination, such as:
· a hesitant, interrupted, weak stream
· urgency and leaking or dribbling
· more frequent urination, especially at night

 j

· =igital Rectal Examination (=RE)
· Prostate-Specific cntigen (PSc) Blood Test
· Rectal ltrasound and Prostate Biopsy
· rine Olow Study
· Cystoscopy

j


· =rug Treatment
· Oinasteride (Proscar) and dutasteride (cvodart), inhibit production of the hormone =HT, which is
involved with prostate enlargement.
· Minimally Invasive Therapy
· Transurethral microwave procedures.
· Transurethral needle ablation.
· Water-induced thermotherapy
· Surgical Treatment
· Transurethral surgery.
· Open surgery
· Laser surgery.
· Photoselective vaporization of the prostate (PVP).
· Interstitial laser coagulation.
 

 

Prostate cancer is the second leading cause of death in the nited States in
men dying from cancer and is the most commonly diagnosed cancer in
cmerican males. Most of the deaths from prostate cancer are related to
advanced disease.

 


· Rectal examination findings of obliteration of the lateral
sulcus or seminal vesical involvement often indicate locally
advanced disease.
· Physical examination findings of adenopathy, lower-
extremity edema, and bony tenderness may indicate
metastatic disease.
· Neurological examination, including determination of
external anal sphincter tone, should be performed to help
detect possible spinal cord compression.

 j

· Hematological workup should include a CBC count and a
chemistry profile, including serum creatinine, liver function
tests, serum PSc, free-to-total PSc ratio, and acid and
alkaline phosphatase.
· rinalysis should be performed.
Imaging Studies
p Bone scan
p Chest radiography
p Computed axial tomography (CT) scan of the abdomen and pelvis or a
magnetic resonance imaging (MRI) study
p ProstaScint scan
p Transrectal ultrasoundʹguided needle biopsy

j


Radiation treatment
cndrogen deprivation therapy
Management of hormone-refractory prostate cancer
Surgical Care
Medication
    

 
 

  

· The nursing management includes administration of prescribed

antibiotics and provision of comfort measures, including prescribed
analgesics and sitz baths.
· The nurse instructs the patient to complete the prescribed course
of antibiotics. Hot sitz baths (10-20 minutes) may be taken several
times a day.
· The major preoperative goals for the patient may include reduced
anxiety and learning about his prostate disorder and the
perioperative experiences.
· The major postoperative goals may include correction of fluid
voulume disturbances, relief of pain and discomfort, ability to
perform self-care activities and absence of complications.
· The nurse explains what will take place as the patient is prepared
for diagnostic tests and then for surgery (depending on the kind of
prostatectomy planned).
 j
  

  


  c-  


 

=uring development of a male fetus, the testes begin growth in the abdomen and
migrate into the scrotum as gestation progresses. The descent usually occurs
during the seventh and eighth months of gestation. Cryptorchidism is the most
common genital problem encountered in pediatrics. Cryptorchidism literally means
hidden or obscure testis and generally refers to an undescended or maldescended
testis.

 


· If your son has an undescended testicle, you'll observe that his testicle or testes have not completely moved down
into the scrotum.

 j

· ndescended testicle is typically diagnosed during the newborn examination. The doctor examines your baby's
groin area, from the hip down to the scrotum.
· Oor unilateral undescended testis without hypospadias, no lab studies are needed.
· Oor unilateral or bilateral undescended testes with hypospadias or bilateral nonpalpable testes, tests include the
following:
· Testing to rule out intersex condition (mandatory)
· 17-hydroxylase progesterone
· Testosterone
· Luteinizing hormone (LH)
· Oollicle-stimulating hormone (OSH)
· Ourther lab studies pending initial results
· To determine anorchia in cases of bilateral nonpalpable gonads, perform the following:
· LH testing
· OSH testing
· Testosterone level testing before and after stimulation with human chorionic gonadotropin (hCh)
· Imaging Studies
· Radiologic studies to localize the testis are currently of very little value. CT scan and ultrasonography are
associated with high false-negative rates in the evaluation of a nonpalpable testis and are not recommended.
Magnetic resonance angiography (MRc) has been reported to have a nearly 100% sensitivity but requires sedation
or anesthesia and is expensive and may not be cost-effective. To date, examination by a pediatric urologist has
proven to be more valuable than ultrasound, CT scan, or MRc findings.
j

 
· Testicles rarely descend on their own after six months of age. Once the doctor has determined the testicle is
unlikely to descend naturally, hormonal therapy, surgery or a combination may be recommended.
   

c hydrocele is a fluid-filled sac surrounding a testicle that results in swelling of

the scrotum, the loose bag of skin underneath the penis.

 


· sually the only indication of a hydrocele is a painless swelling of one or both
testicles.

 j

· Screening and diagnosis entails a physical exam, which may reveal an enlarged
scrotum that isn't tender to the touch. Pressure to the abdomen or scrotum may
enlarge or shrink the fluid-filled sac, which may indicate an associated inguinal
hernia.
· The fluid surrounding the testicle may keep the testicle from being felt. In that
case, further study may be needed. Possible tests include:
· ltrasound imaging. This test, which uses high-frequency sound waves to create
images of structures inside your body, may be used to rule out a testicular tumor
or other cause of scrotal swelling.
· cbdominal X-ray. c basic X-ray uses electromagnetic radiation to make images of
your bones, teeth and internal organs. cn X-ray may distinguish a hydrocele from
an inguinal hernia.

j

  
· Oor baby boys, hydroceles typically disappear on their own within a year. If a
hydrocele doesn't disappear after a year or if it continues to enlarge, it may need
to be surgically removed.
· Surgical excision (hydrocelectomy).
· Needle aspiration
 
 

clternative Names: Hematocele; Spermatocele

c scrotal mass can be benign (generally harmless) or malignant (cancerous). Benign
scrotal masses include:
· Varicocele -- a varicose vein along the spermatic cord
· Hydrocele -- fluid collection in the scrotum
· Hematocele -- blood collection within the scrotum
· Spermatocele -- a cyst-like mass within the scrotum that contains fluid and dead sperm
cells

 


· Painless or painful bulge or lump within the scrotum (testicle lump)
· Infertility
· Enlarged scrotum

 j

· =uring a physical examination, the doctor may feel a mass within the scrotum and make note
of its features:
· Tender or non-tender
· niform, smooth, twisted, or irregular
· Oluctuant (feels liquid), firm, or solid
· ltrasound of the scrotum
· Biopsy on masses that are surgically removed

j


· cll scrotal masses should be evaluated by a primary health care provider. Hematoceles,
hydroceles, and spermatoceles are usuallyharmless and do not require treatment. Sudden,
temporary conditions may respond to local comfort measures and, in some situations,
antibiotics or pain relievers.
·
· c scrotal support (jock strap) may provide some relief of the pain or discomfort associated
with the scrotal mass. c hematocele, hydrocele, or spermatocele may occasionally require
surgery to remove the collection of blood, fluid, or dead cells.


 

c spermatocele is a cyst that develops in the epididymis Ͷ the small, coiled

tube situated in the upper testicle that collects and transports sperm.

 


· =iscomfort
· Pain
· c feeling of heaviness

 j

· Transillumination. ¢our doctor may shine a light through your scrotum. With a
spermatocele, the light will indicate that the mass is fluid-filled rather than solid.
· ltrasound. If transillumination indicates a fluid-filled mass, your doctor may order
an ultrasound to confirm the diagnosis. If transillumination doesn't clearly indicate
a cyst, an ultrasound can help determine what else it might be. This test, which
uses high-frequency sound waves to create images of structures, may be used to
rule out a testicular tumor or other cause of scrotal swelling

j

  
· Most spermatoceles require no treatment. If yours causes discomfort, your doctor
may recommend that you take over-the-counter pain medications, such as
acetaminophen (Tylenol, others) or ibuprofen (Motrin, cdvil, others).
· Surgical treatments:
p Repairing a spermatocele requires surgery to remove the cyst. c procedure
called a spermatocelectomy generally is performed on an outpatient basis,
using local or general anesthetic. The surgeon makes an incision in the
scrotum and separates the spermatocele from the epididymis.
  

c varicocele is an enlargement of the veins within the scrotum, the loose bag
of skin that holds your testicles. c varicocele is similar to a varicose vein
that can occur in your leg.

 


· c varicocele often produces no symptoms. Rarely, it may cause pain
that may worsen over the course of a day because of physical
exertion and typically is relieved by lying down on your back. With
time, varicoceles may grow larger and become more noticeable.


 j

· ¢our doctor will conduct a physical exam, which may reveal a
twisted, nontender mass above your testicle.
· If the physical exam is inconclusive, your doctor may order a scrotal
ultrasound.

j


· Repair methods include:
· Open surgery
· Laparoscopic surgery
· Percutaneous embolization.
 j
  j

Testicular torsion is a true urologic emergency and must be differentiated from

other complaints of testicular pain because a delay in diagnosis and
management can lead to loss of the testicle. In adolescent males, testicular
torsion is the most frequent cause of testicle loss

 


Scrotal swelling
Nausea and vomiting
cbdominal pain
Oever
rinary frequency

 j

· rinalysis
· Complete blood count
· ccute-phase proteins (C-reactive protein [CRP]):


 
p Color =oppler ultrasonography
j


· Mild analgesic pain relief can be administered once testicular
torsion has been diagnosed or while awaiting further studies.
· cttempt manual detorsion, which can be attempted with pain relief
as the guide for successful detorsion. The procedure is similar to the
"opening of a book" when the physician is standing at the patient's
feet.
 
   


  


The epididymis is a coiled tubular structure located along the posterior aspect of
the testis. It allows for the storage, maturation, and transport of sperm,
connecting the efferent ducts of the testis to the vas deferens. Inflammation
of the epididymis can be acute (<6 wk) or chronic and is most commonly
caused by infection.

 


Symptoms include the following:
· Scrotal pain and edema
· rinary frequency, urgency, or dysuria
· rinary retention from bladder outlet obstruction in older patients
· Nausea
· Oever and chills
· cbdominal or flank pain
· Bilateral epididymal involvement (10%)
· rethral discharge


 j

· rinalysis - Pyuria or bacteriuria (50%); urine culture indicated for prepubertal and
elderly patients
· CBC - Leukocytosis
· hram stain of urethral discharge, if present
· rethral culture, nucleic acid hybridization, and nucleic acid amplification tests
(These tests aid in detection of þ 
ÊÊ and 

· Performance of (or referral for) syphilis and HIV testing in patients with a sexually
transmitted etiology
· Imaging Studies
p Radionuclide scintigraphy
p Color-coded =oppler ultrasonography
Treatment
· Obtain immediate urologic consultation if unable to
clearly differentiate testicular torsion from epididymitis
or other scrotal pathology.
· cntibiotic therapy
· cnalgesics for pain control
· Supportive care
Scrotal elevation and support
Ice pack
Spermatic cord block (possibly)
· Medication
 


Orchitis is an acute inflammatory reaction of the testis secondary to infection.

Most cases are associated with a viral mumps infection; however, other
viruses and bacteria can cause orchitis.

 


· Orchitis is characterized by testicular pain and swelling.
· The course is variable and ranges from mild discomfort to severe pain.
· cssociated systemic symptoms
Oatigue
Malaise
Myalgias
Oever and chills
Nausea
Headache
· Testicular examination
Testicular enlargement
Induration of the testis
Tenderness
Erythematous scrotal skin
Edematous scrotal skin
Enlarged epididymis associated with epididymo-orchitis
· Rectal examination
Soft boggy prostate (prostatitis) often associated with epididymo-orchitis
Stool for occult blood
· Other
Parotitis
Oever


#
· Laboratory tests are not helpful in making the diagnosis in the E=.
· =iagnosing mumps orchitis can be comfortably made based on
history and physical examination alone. However, if epididymo-
orchitis is a concern, urine dip, urinalysis, and urethral cultures
should be obtained.
· =iagnosing mumps orchitis can be confirmed with serum
immunofluorescence antibody testing.
· Imaging Studies
· Color =oppler ultrasonography has become the imaging test of
choice for the evaluation of an acute scrotum.
j


· Supportive treatment
Bed rest
Hot or cold packs for analgesia
· Medication
· No medications are indicated for the treatment of viral orchitis.
· Bacterial orchitis or epididymo-orchitis requires appropriate
antibiotic coverage for suspected infectious agents
  


 

Cancer of the scrotal skin usually occurs over the age of 50 years.
Scrotal cancer causes an ulcer or lump on the skin. This is often painless and not tender. It
will start off small and round but will enlarge to form an irregular shape. Eventually, a
pus-stained discharge appears, and if the ulcer is hidden in the fold between the
scrotum and leg, this may be the first thing noticed. Sometimes lumps in the groin
(swollen glands) are the first sign of a problem, though the scrotal lesion will have been
present for some time before the cancer spreads to these lymph nodes. The diagnosis is
made with a biopsy and, depending on size; the tumour is treated by surgical removal,
radiotherapy, cryotherapy (extreme cold) or chemotherapy.
 j
  

Testicular cancer occurs in the testicles (testes), which are located inside the
scrotum, a loose bag of skin underneath the penis. The testicles produce
male sex hormones and sperm for reproduction.

 


· c lump or enlargement in either testicle
· c feeling of heaviness in the scrotum
· c dull ache in the abdomen or groin
· c sudden collection of fluid in the scrotum
· Pain or discomfort in a testicle or the scrotum
· Enlargement or tenderness of the breasts
· nexplained fatigue or a general feeling of not being well
· Cancer usually affects only one testicle

 j

· To determine whether cancer has spread outside of your testicle, you may
undergo:
· Computerized tomography (CT). CT scans take a series of X-ray images of
your abdomen. ¢our doctor uses CT scans to look for signs of cancer in
your abdominal lymph nodes.
· X-ray. cn X-ray of your chest may determine whether cancer has spread to
your lungs.
· Blood tests. Blood tests to look for elevated tumor markers can help your
doctor understand whether cancer likely remains in your body after your
testicle is removed.
j


· Surgery
Surgery to remove your testicle (radical inguinal orchiectomy)
¢ou may also have surgery to remove the lymph nodes in your groin (retroperitoneal lymph
node dissection).
· Radiation therapy
· Chemotherapy
   


 j
  

  
· The patient is placed on bed rest, and the scrotum is elevated with a scrotal bridge
or folded towel to prevent traction on the spermatic cord and to promote venous
drainage and relieve pain.
· cntimicrobials are administered as prescribed until the acute inflammation
subsides.
· The nurse instructs the patient to avoid straining, lifting and sexual stimulation
until the infection is under control. He should continue taking analgesics and
antibiotics as prescribed and using ice packs if necessary to relieve discomfort.
· Patient needs encouragement to maintain a positive attitude during what may be
a long course of therapy. He also needs to know that radiation therapy will not
necessarily prevent him from fathering children, nor does unilateral excision of a
tumor necessarily decrease virility.
· Oor patient undergoing surgery, ice bags are applied intermittently to the scrotum
for several hours after surgery to reduce swelling and to relieve discomfort.
· The nurse advises the patient to wear cotton, jockey-type briefs for added comfort
and support.
    

  c-  
 

Hypospadias is a condition in which the opening of the urethra is on the underside of the
penis, instead of at the tip. The urethra is the tube through which urine drains from the
bladder and exits the body.

 


· =ownward curve in the penis (chordee)
· Hooded appearance of the penis because only the top
half of the penis is covered by foreskin
· cbnormal spraying during urination


 j

· ¢our son's doctor can diagnose hypospadias based on a
physical examination.

j

  
· Treatment involves surgery to reposition the urethral
opening and, if necessary, straighten the shaft of the
penis.

 

Epispadias (also called bladder exstrophy) is a congenital defect of males in

which the urethra opens on the upper surface (dorsum) of the penis.

 j

· Obtain a complete blood cell count.
· Imaging Studies
Obtain a chest radiograph if indicated based on examination
findings or the patient's history.
Radiologic (eg, intravenous pyelogram) and ultrasound
evaluations of the urogenital system (eg, kidneys, ureters,
bladder; urethra, genitalia) are usually necessary to evaluate the
extent of the defect.
· Other Tests
Obtain an ECh for operating room guidelines4

j


· Surgery is the treatment of choice for both hypospadias
and epispadias. cll surgical repairs should be undertaken
early and completed without delay.
   


Phimosis, or preputial stenosis, is a term that usually

means any condition where the foreskin of the penis
cannot be retracted.

 



· Phimosis is usually painless condition. Infection may result from an

inability to carry out effective cleaning of the area in which case swelling,
redness and discharge may all be present making the area tender and
painful. c very tight foreskin can cause problems during intercourse,
urination.


 j

· Phimosis and paraphimosis are clinical diagnoses, thus lab and imaging
studies are not indicated.

j


If treatment is required there are three main types:

Tropical creams, steroidal and non steroidal, applied to the prepuce.

hradual stretching of the opening of the prepuce to widen it.
Surgical reshaping of the prepuce to make it wider.
 

cn inability to pull back the foreskin into position over

the head of the penis can cause pain, swelling of the
head of the penis and the foreskin.

 


· Edema, tenderness, and erythema of the glans
· Edema of the distal foreskin
· Olaccidity of the penile shaft proximal to the area of
paraphimosis (unless there is accompanying
balanoposthitis or infection of the penis)
· Ensure the absence of an encircling foreign body, such as
hair, clothing, metallic objects, or rubber bands.


 j

· Phimosis and paraphimosis are clinical diagnoses, thus lab
and imaging studies are not indicated.

j


· Paraphimosis reduction
 % 
  % 


% 


Balanitis is an inflammation of the glans penis. In

balanoposthitis, the glans (tip) of the penis becomes irritated
and inflamed as a result of bacterial or fungal infection,
irritation from chemicals in clothing, or an unknown cause.

 



· The incubation period varies from 3 days to 1 week. The first signs
of involvement may be small red erosions on the glans or
undersurface of the prepuce, with concomitant development of
much preputial exudation; the purulent discharge may be
accompanied by phimosis. If the disease is unchecked, confluent
ulcerations will develop along with considerable edema of the
penis.

j


· Since anaerobic conditions are necessary for growth of the

offending organisms, simple exposure to air and local cleansing is
most often effective. Oormerly, this treatment, used with peroxide
powder and arsphenamine and, in severe cases, a dorsal slit, was
the extent of therapy. With the advent of penicillin and other
systemic and local antibiotics, the treatment is specific and
effective.
 % 



=efined as the inflammation of the foreskin and glans in

uncircumcised males, balanoposthitis occurs over a wide
age range and may have any of multiple bacterial or
fungal origins or be caused by contact dermatitides.

 


· Examination of the glans and the prepuce often reveals a red, moist macular
lesion.
· cssociated erythema is noted, and areas of yellow-to-black discoloration have
been described.
· The presence of lichenification, irregular borders, or acetowhite changes with 5%
acetic acid treatment suggest an HPV infection, which can be seen in association
with balanoposthitis.
· c superimposed balanoposthitis on a flat condyloma has been described. Such
coexisting lesions may be diagnosed based on the clinical history and a culture of
fungus or bacteria from the ulcer.
· lceration and deep erosion have been seen in patients with advanced disease,
often in association with fungal infections and in individuals who are
immunocompromised.


 j

· Potassium hydroxide (*OH) slide preparation and culture for 

 species
· Imaging Studies
No imaging studies are indicated.
· Other Tests
Rarely, serologic tests for candidal species may be indicated, particularly in
unclear cases and for academic interest.
Biopsy from the involved area
Treatment
· Topical antibiotics (metronidazole cream) and
antifungals (clotrimazole cream) or low-potency
steroid creams for contact dermatitides often
lead to clearing of the lesion.
· Proper hygiene with frequent washing and drying
of the prepuce is an essential preventive
measure.
· Surgical Care
Circumcision may be advocated in recurrent and
recalcitrant cases.
· Medications
 & 

Peyronie's (pa-ro-NEEZ) disease causes a bent penis during

erection. c hard, fibrous layer of scar tissue (plaque) develops
under the skin on the upper or lower side of the penis

 


· Painful erection
· c bend or curve in your penis during erection
· c thick band of hard tissue on one or more sides of your penis
· Indentation, or an "hourglass-shaped" penis during erection
· Impaired ability to obtain an erection (erectile dysfunction, or E=)
· Shrinking or shortening of your penis

j


·   

 4 This medication inhibits growth of collagen and may improve
symptoms of Peyronie's disease. However, common side effects include
digestive problems and diarrhea.

  .
 !
 "4 Taken orally, this prescription medication
may help treat Peyronie's disease. However, like vitamin E, more research is
needed to determine the medication's effectiveness. The medication is
expensive, requiring taking up to 24 tablets daily, and side effects include
digestive problems.


4 Researchers have reported that vitamin E may improve Peyronie's
disease when taken orally, although more controlled studies are needed to
verify the effectiveness of vitamin E therapy. Talk to your doctor before taking
vitamin E, as it may not be safe in high doses.
  
    :
 
 
4 Tissue on the unaffected side of the
penis is shortened, canceling the bending effect. This
type of surgery can shorten the penis. It is generally
used in men who have adequate penis length and a
curve of less than 45 degrees.
 -  
   
4 Several
linear cuts are made in the plaque, which allows
straightening. The cut plaque is then covered with a
grafted vein. This procedure is generally used in men
who have a shorter penis, a curve of more than 45
degrees or an hourglass-shaped deformity.
  
4 cn implanted device is used to
straighten and increase the rigidity of the penis. This
type of surgery is for men who have trouble
maintaining an erection (erectile dysfunction).
   

  



  

Erectile dysfunction (E=) is the inability of a man to maintain a firm erection long
enough to have sex.

 


· Erectile dysfunction is the inability to maintain an erection sufficient for sexual intercourse at least
25 percent of the time.


 j

· ltrasound
· Neurological evaluation
· Nocturnal tumescence test

j

  
Oral medications
Sildenafil (Viagra)
Tadalafil (Cialis)
Vardenafil (Levitra)
Prostaglandin E (alprostadil)
Hormone replacement therapy
Vascular surgery
Penis pumps
penile implants
 
Priapism is the presence of a persistent, usually painful, erection of the penis unrelated to sexual
stimulation or desire.

 


· crterial high-flow priapism
Priapism secondary to arterial causes also may be significantly less painful than venous priapism.
Onset of priapism may be delayed after the acute injury. The delay may be due to vessel spasm initially or to
the formation of a clot that is gradually reabsorbed over a period of days.
Priapism secondary to arterial causes usually is less tumescent when compared with venous priapism.
· Veno-occlusive priapism
Patients with veno-occlusive priapism present with a painful erection.
Erection may have been present for hours to days.


 j

· complete blood count (CBC)
· Coagulation profile
· Platelet count
· rinalysis
· Imaging Studies
· Color flow penile =oppler imaging is currently the study of choice to differentiate high-flow from
low-flow priapism.
· In patients with high-flow priapism, selective penile angiography may be required in order to
identify the site of the fistula.

j


· Medication
  
 

Penile cancer is a disease in which malignant (cancer)

cells form in the tissues of the penis.

  


The first signs of a penile cancer are often a change in

colour of the skin and skin thickening. Later symptoms
include a growth or sore on the penis, especially on the
glans (head of the penis) or foreskin, but also
sometimes on the shaft of the penis. There may be a
discharge or bleeding. Most penile cancers are
painless.


 j

· CT (computerised tomography) scan c CT scan
· Lymph node biopsy
· MRI (magnetic resonance imaging
· ltrasound exam



Stage 1 The cancer only affects the skin covering the
penis, the head of the penis (glans) or the foreskin.
Stage 2 The cancer has begun to spread into the shaft
of the penis or into one of the lymph nodes in the
groin.
Stage 3 The cancer has spread deep into the shaft of
the penis or to many lymph nodes in the groin.
Stage 4 The cancer has spread to lymph nodes deep in
the pelvis, or to other parts of the body.

j


· The treatments used for penile cancer include
surgery, which is the main treatment,
radiotherapy and chemotherapy.
    


  
 
· The nurse should inform patients that support groups for men with penile and erectile
dysfunction and their partners have been established.
· The nurse should be aware that the ability to satisfy a partner and personal satisfaction are
common concerns of the patients.
· People with illness and disabilities may need the assistance of a sex therapist to find,
implement, and integrate their sexual beliefs and behaviours into a healthy and satisfying
lifestyle.
· The patient is placed on bed rest, and the scrotum is elevated with a scrotal bridge or folded
towel to prevent traction on the spermatic cord and to promote venous drainage and relieve
pain.
· cntimicrobials are administered as prescribed until the acute inflammation subsides.
· The nurse instructs the patient to avoid straining, lifting and sexual stimulation until the
infection is under control. He should continue taking analgesics and antibiotics as prescribed
and using ice packs if necessary to relieve discomfort.
· Patient needs encouragement to maintain a positive attitude during what may be a long
course of therapy. He also needs to know that radiation therapy will not necessarily prevent
him from fathering children, nor does unilateral excision of a tumor necessarily decrease
virility.
· Oor patient undergoing surgery, ice bags are applied intermittently to the scrotum for several
hours after surgery to reduce swelling and to relieve discomfort.
· The nurse advises the patient to wear cotton, jockey-type briefs for added comfort and
support.


c jc
jj



c


 

#



 
    !  

c
"

Human papillomaviruses (HPVs) produce epithelial tumors of the

skin and mucous membranes. The current classification system,
which is based on similarities in their genomic sequences, generally
correlates with the 3 categories used to describe HPV clinically:
anogenital and/or mucosal, nongenital cutaneous, and
epidermodysplasia verruciformis (EV).

 j

· Cytologic testing
· HPV =Nc typing
· Tissue biopsy

j


· cll medicines used to treat HPV disease are applied topically on cutaneous
surfaces. Local skin reactions and pain are common adverse effects.
· The keratolytics are the only agents that are recommended for treatment
of nongenital cutaneous warts.
Imiquimod
Interferon alfa
Podofilox
Podophyllin
5-Oluorouracil
*eratolytics
· Surgery
Primary surgical therapy can often be accomplished in the office and includes
cryosurgery; electrosurgery with either electrodesiccation or loop
electrosurgical excision procedure (LEEP); or simple surgical excision with a
scalpel, scissors, or curette.
· Medications
 
 

Herpes is a sexually transmitted disease (ST=) caused by

the herpes simplex virus (HSV). It is more common in
women (1 out of 4) than in men (1 out of 5) possibly
because male to female transmission is more efficient
than female to male transmission.

 


Early symptoms may include:
burning sensation in the genitals
flu-like symptoms
lower back pain
pain when urinating
Other symptoms include:
fever
headache
infection of the urethra causing a burning sensation when urinating
muscle ache
painful inflamed blisters which develop around the infected area
swollen lymph glands
vaginal or penis discharge


 j

· Blood Test
· Microscopic Examination of Tissue Scrapings
· Viral Cell Culture Test
· Immune Response Tests
· Other available tests:
p cntigen test
p Pap Smear
j


· henital herpes is manageable. Over the years, a
number of treatments offering effective relief
from symptoms of genital herpes and cold sores
have been developed.
These include:
Prescription drugs
OTC "cold sore" treatments,
Herbal remedies
Vitamins
Nutritional changes
Psychotherapy
   


Molluscum contagiosum is a benign viral infection of

the skin but is not particularly harmful or painful.

 


· Molluscum causes normal skin to grow into bumps. There is no pain or
discharge from these but they may bleed if cut. Symptoms usually
appear between 2-12 weeks after being exposed to the infection, but
can take years to manifest.


 j

· =iagnosis is usually ascertained by:
· Observation of the classical skin lesion
· Tissue taken from the sore and examined under a microscope

j


· Burning growths off with a potent acid, such as Trichloracetic ccid
· Electrical current
· Oreezing the growths with liquid nitrogen
· Laser surgery using a blistering agent, such as Podophyllin which is
made from rainforest beetles)
· Retin c ® a common acne treatment (often used with children)
 

· Chancroid (*an-kroid) is also known as:

soft chancre
venereal sore
· Chancroid ( human genital ulcer disease) is an ST= caused by exposure to:
˜Ê

Ê (a small gram-negative rod organism) which occurs mainly in
developing countries, especially the cfrican, csian and Latin cmerican nations.

 


In men
1-4 sores on the penis may develop
Buboes appear in about 50% of male patients
The foreskin may swell

In women
Buboes are uncommon in women
=yspareunia (painful sex)
=ysuria (painful urination)
Painless sores can develop on the cervix
Several sores may develop around the vagina and rectum
Vaginal discharge


 j

· Culture or biopsy
· hram Stain
· Microscopic examination of a smear sample taken from the patient's sores

j


· Current treatment involves regular doses for up to two weeks of:
· Ciprofloxacin
· Erythromycin
· Trimethoprin
· or a single dose of:
czithromycin
Ceftriaxone
    

hranuloma inguinale is also known as: =   

  Ê ÊÊ
hranuloma inguinale is a sexually transmitted disease (ST=)
occurring more frequently in males. It is caused by a bacteria
usually found in the tropics and subtropical areas and is
chronic and mildly contagious.

 


In men
· Lesions first appear:
· on the head of the penis
· on the shaft of the penis

In women
· Lesions first appear:
· at the entrance to the vagina
· at the inner labia
· If untreated the sores grow larger and spread throughout the groin, which
can cause:
· abscesses
· cancer (in rare cases)
· intestinal and rectal symptoms
· secondary infections
· Other symptoms
· Swelling of the lymph nodes

 j

· Blood tests (to determine it is not another ST= with similar symptoms)
· Microscopic examination of cells from the edge of the sores
· Tissue sample collected by biopsy
· Visual observation of external symptoms

j


· To eliminate the infection a two-week course of antibiotics is usually

administered using:
czithromycin, which has been used successfully with custralian aborigines
Ciprofloxacin, which has better bioavailability than Norfloxacin
=oxycicline is recommended based on trials carried out with older
Tetracyclines
Erythromycin
hentamicin is recommended to patients whose lesions do not respond to
other medication in the first few days
Minocycline
Sulfamethoxazole
Tetracycline
   

· Lymphogranuloma inguinale is also known as:

Lymphogranuloma venereum (LhV)
Nicholas-Oavre =isease
Sixth Venereal=isease
Tropical Bubo
· Lymphogranuloma inguinale is an infection of the lymph tissue in the genital area
caused by a strain of Chlamydia trachomatis, the bacterium that produces
Nongonococcal rethritis (Nh ).

 


· c small, painless sore similar to a pimple, blister/lesion/soft bump occurring at the
point where the bacterium entered the body (usually the penis or vagina) that
often goes unnoticed
· Some people do not experience this and if they do healing is usually rapid without
scarring
· The infection then spreads to the lymph nodes in the groin area and from there to
the surrounding tissue, where it causes painful swelling closest to the point of
infection
· =ischarge from the penis or vagina from 3-30 days after exposure
· Inflammation and swelling of lymph nodes and surrounding tissue
· Lymph nodes closest to the infection continue to swell until a pus-filled bulge is
created, called a bubo
· Throbbing pain and fever


 j

· c blood test
· c sample of the discharge for a culture test
· Visual observation
· =irect Immuno-fluorescence (=IO)
· Enzyme immunoassay (EIc)
· Other Methods
· Ligase chain reaction (LCR) or polymerase chain reaction (PCR)
j


cntibiotics used:

czithromycin
Chloramphenicol (effective against Chlamydia
trachomatis)
=oxycycline
Erythromycin
Isulfamethoxazole
Minocycline
Rifampicin
Sulfadiazine
Tetracycline
  

  

¢east infections are generally caused by an organism called



  or Candidiasis and there is no direct
evidence that it is passed through sexual intercourse.



In Women
· burning of the vagina
· burning when urinating
· discomfort during or after sexual intercourse
· odor (not unpleasant)
· irritation of the vagina
· itching and burning of the female genitals (vulva)
· itching of the vagina
· painful urination
· painful intercourse
· vulva redness and swelling
In Men
· Men may not experience any symptoms of the infection, however, if symptoms are present they
may include:
· burning sensation during intercourse
· burning sensation of the penis
· symptoms after intercourse if condoms not used
· transient rash


 j

· Laboratory Tests

j


· a. Various anti-fungal vaginal medications are available to treat yeast infection in the form of:
anti-fungal creams
anti-fungal suppositories
anti-fungal tablets
 j

· Trichomonas is a common sexually transmitted disease caused

by a single-cell parasitic protozoan,
· It is often diagnosed in patients who are already infected with
other ST=s such as:
gonorrhea
nongonococcal urethritis (Nh )

 


In women
blood spotting in vaginal discharge
heavy, yellowish-green or gray, frothy vaginal discharge
infection in the urethra, the tube that carries urine from the bladder out of the body
itching, burning or pain in the vagina
lower abdominal pain
musty vaginal odor
pain and/or burning when urinating
pain or discomfort during sexual intercourse (dyspareunia)
swelling in the groin
swollen and irritated vagina and cervix
urinating more than usual
vaginal or vulval redness
worsening symptoms when menstruating
In Men
Men rarely have any symptoms, however, if symptoms do occur they include:
infection of the urethra or prostate gland, which is involved in semen production
painful and/or difficult urination
thin, whitish discharge from the penis
tingling inside the penis

 j

· Culture Tests
· Examination under a Microscope
· Laboratory Testing
· Pap smear
j


· cntibiotics are usually successful (cure rate 95%) even though this infection is not a bacteria. It is
usually administered in a single dose.
 %
  ! 
"

· Bacterial vaginosis (BV) is also called:


ÊÊ-associated vaginitis
nonspecific vaginitis
· It is one of the most common causes of vaginitis symptoms among
women, particularly those who are sexually active, producing painful
inflammation of the vagina.

 


· excessive, thin gray or white vaginal discharge that sticks to the vaginal
walls
· fishy or musty, unpleasant vaginal odor, most noticeable after sex
· vaginal itching and irritation


 j

· Physical Examination
· Laboratory Tests
· cs an added confirmation
· The sample is mixed with potassium hydroxide and produces a strong fishy
odor when the bacteria is present

j


· The usual treatment is antibiotics, taken orally or vaginally, including:
cmpicillin
Ceftriaxone
Clindamycin,
Metronidazole
Tetracycline
  ,


 

   


· Chlamydia is actually a group of different infections caused by different strains of the

Chlamydia bacterium:


 Ê  causes a type of walking pneumonia


causes a type of pneumonia caused by birds



 causes various sexually transmitted diseases

 


In Women
· Constant lower abdominal pain
· Mild, milky or yellow mucus-like vaginal discharge
· Nausea and fever
· Pain during urination
· Pain during sexual intercourse
· Spotting between periods
In men
· Burning on urination (non-gonoccocal urethritis (Nh ))
· hroin pain and swelling (Epididymitis)
· Irritation around opening of the penis
· Mild, sticky, milky or mucus-like discharge from penis
· Pain when urinating
· Swollen testes (which if not treated can lead to infertility)
· Testicular pain


 j

· Laboratory Tests
· Culture
· =Nc amplification
· cmplicor Chlamydia Trachomatis Test

j


· cmoxicillin
· czithromycin (one-day course)
· =oxycycline (seven day course) *
· Erythromycin *
· Tetracycline (some people are allergic to the drug)
· Ofloxacin
* able to be used during pregnancy
 

· honorrhea honococcal Infection (clap, drip)

· honorrhea is:
an infection that is spread through sexual contact with another person
caused by a bacterium, þÊÊ  
ÊÊ
Second only to Chlamydial infections in the number of reported cases.

 


· In Men:
· Creamy or green, pus-like discharge from the penis
· Painful urination (burning sensation)
· Testicular pain
In Women:
· Bleeding between periods
· Creamy or green, pus-like or bloody vaginal discharge
· Excessive bleeding during menstrual period
· Irritation of the vulva
· Lower abdominal pain
· Painful intercourse
· Painful urination (burning sensation)
· Rectal infection
· Throat infection


 j

· Staining Biological Samples
· =etection of Bacterial henes or Nucleic ccid (=Nc) Test
· Cultures

j


· honorrhea is treated with penicillin or other antibiotics in pill form or by injection, however, the disease is
becoming more and more resistant to many standard medications.
· cntibiotics that are currently used are:
Cefixime
Ceftriaxone
Ciprofloxacin*
Ofloxacin*
Tetracycline

 

· Syphilis is a sexually transmitted disease (ST=) caused by a bacterium

(jÊ Ê
). The initial infection causes an ulcer at the site of
infection.

 


· a rash of flat, red lesions over the whole body (including the palms of the hands
and soles of the feet)
· fever
· swollen glands
· broad-based papules (lumps or warts) in warm, moist sites
· mucous patches or snail-track ulcers in the mouth, appearing from 3-6 weeks after
the chancre develops


 j

· Three methods may be used in diagnosis of syphilis:
Blood tests
Microscopic identification of syphilis bacteria
Recognition of the signs and symptoms during normal medical consultation
· c confirmatory blood test is carried out when the initial test is positive, such as:
The fluorescent treponemal antibody-absorption (OTc-cBS) test (70-90% accuracy)
T. pallidum hemagglutination assay (TPHc) test

j


Syphilis is treated with penicillin, usually administered by injection. c person no longer
usually transmits syphilis 24 hours after beginning treatment.
    

 


#  j

 
· henital herpes causes physical pain and emotional distress. sually, the
patient is upset on learning the diagnosis. Therefore, when counseling the
patient, the nurse should explain the causes of the condition and the
manner in which it can be managed.
· The nurse can provide reassurance that the lesions will heal and that
recurrences can be minimized by adopting a healthful lifestyle and by
taking prescribed medications.
· Because Chlamydia, gonorrhe, and other ST=͛s may have serious effect on
future health and fertility and because many ST=͛s can be prevented by
the use of condoms, spermicides and discriminatory choice of partners,
the nurse has a major role in discussion of sex that is as safe as possible.
· Exploring options with patients, determining their use of safer sex
practices and their knowledge deficits, and correcting misinformation may
prevent morbidity and mortality.
· The major goals for the patient may include relief of pain and discomfort;
reduction of anxiety related to stress symptoms; prevention of reinfection
or infection of sexual partner; and acquisition of knowledge about
methods for preventing vulvovaginal infections and managing self-care.
  j     


  
  
  
  , /
    0
Her theory focuses on manipulation of the physical environment as the major
component of nursing care. She stressed the importance of pure air, pure water,
efficient drainage, cleanliness and light. The goal of the nurse if to assist the
patient in staying in balance and if the environment of the client is out of balance,
the client expends unnecessary energy. She stressed that nursing creates the
environment most conducive to body͛s ͞reparative processes.͟

   1 /(+ 
  %  0

Her theory is to assist the individual, sick or well, in the performance of those
activities contributing to health or its recovery (or to peaceful death) that he
would perform unaided if he had the necessary strength, will or knowledge. cnd
to do this in such a way as to help him gain independence as rapidly as possible.
She stressed the importance of the ͞14 Components of Basic Nursing Care.͟

   1 /2 2   c
0

Her theory states that nursing is participation in care, core and cure aspects of patient
care, where CcRE is the sole function of nurses, whereas the CORE and C RE are
shared with other members of the health team. She stressed that the major
purpose of care is to achieve an interpersonal relationship with the individual that
will facilitate the development of the core.


4  1 /
 , 
j  0
Her theory states that nursing is needed when the self-care demands are greater than
the self-care abilities. She defines three steps of nursing process as (1) diagnosis
and prescription, (2) design of the nursing system and planning for the delivery of
care, and (3) production and management of nursing systems.

   c   1 /j
    0

Her theory states that nursing is broadly grouped into the 21 problem areas to guide
care and promote the use of nursing judgement. She stressed that nursing is a
comprehensive service that is based on the art and science and aims to help
people, sick or well, cope with their health needs.

 3 1 / c


j0

Her theory states that nursing is a process of action, reaction, and interaction whereby
nurse and client share information about their perception in the nursing situation.

4 :
 1 /j   

  0
Her theory states that nursing is concerned with promoting health, preventing illness,
caring for the sick, and restoring health. She stressed that nursing is a human
science of persons and human health-illness experiences that are mediated by
professional, personal, scientific, esthetic, and ethical human care transactions.