Repro 2

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Dysmenorrhea: painful menstruation
Can be primary or secondary
Dysmenorrhea
* Primary: no associated pathology, but can be associated with abnormally high levels of prostaglandins, poor hygiene, anxiety related to menstruation
* Secondary: pelvic disease present.
Common causes:
endometriosis, cervical os stenosis, fibroids, cancer
Menorrhagia: abnormally heavy menstrual flow, greater than 80cc per menses
Leukorrhea: any vaginal discharge than blood- often a symptom of vaginal or cervical infection
Endometrosis medical management: mild analgesics, NSAIDS, OCPs
Comfort measures: heating pads, relaxation, biofeedback
Menstruation: * Bleeding occurs in response to hormonal changes
* Average interval between cycles is 28 days (can range from 23-35 days)
* Average duration of flow is 2-7 days
* Average blood loss is 30-80cc
* Requires intact hypothalamus, pituitary gland, ovaries, and uterus
Amenorrhea: * Defined absence of menstrual flow
* What is the most common cause????
* Other causes: anxiety, fatigue, chronic illness, extreme dieting, strenuous exercise
Metorrhagia: bleeding between menstrual periods
Endometriosis: * Defined as abnormal growth of extra uterine endometrial cells, often in cul-de-sac of peritoneal cavity, the uterine ligaments, and the ovaries
* Results from excessive endometrial production and reflux of blood and tissue through the fallopian tubes during menstrual flow
* Causes intense pain
* Can lead to infertility
* Can lead to painful intercourse
* Treatment can be medical or surgical
Premenstrual Syndrome: * Symptoms occur during the luteal phase of menstrual cycle
* Affects women of all races, socioeconomic levels, and all educational levels
* Most common in 30-40 year olds
* Severity increases with age until menopause
PMS Emotional symptoms: irritability, easily induced crying spells, low self esteem, anxiety, and depression
PMS Risk factors: after pregnancy, childbirth, and tubal ligation; perimenopausal years, and during major life stresses
PMS Physical symptoms: breast tenderness, bloating, fluid retention, increased appetite and food cravings, insomnia, fatigue, hot flashes, headaches, and musculoskeletal discomfort
PMS Cognitive symptoms: short term memory problems, difficulty concentrating, and unclear thinking
PMS treatment: * Diet: eliminate caffeine; limit sodium intake
* Medications (most are controversial)
mild K+ sparing diuretics, progesterone, Parlodel, OCPs, antidepressants, prostaglandin inhibitors, and NSAIDS
Menopause: * Refers to the last menstrual period- the actual date cannot be determined until one year passes without menses
* FSH and LH levels increase
* Decreased estrogen levels affect the reproductive system, CV system, and bone density
Effects of Menopause: * Reproductive system: uterus, cervix, ovaries, labia, and clitoris shrink in size; vaginal mucosa becomes thin and dry; pelvic floor relaxes
* Bone density decreases, leading to osteoporosis
* During perimenopausal phase: hot flashes, emotional changes, and fatigue
Cervical Cancer: * Pap smears have decreased the death rate from cervical CA, because of the ability to detect pre-malignant changes
* Risk factors: low socioeconomic status, early age of 1st intercourse or 1st pregnancy, intrauterine exposure to DES, cigarette smoking, exposure to HSV/ cytomegalovirus, and HPV
* Classic symptom: painless vaginal bleeding (starts as spotting between menstrual periods or after sexÂ– as malignancy grows, the bleeding increases in frequency, duration, and amount)
* Treatment varies on stage of cancer and includes many non-surgical and surgical techniques
Ovarian Cancer: * Leading cause of death from female reproductive malignancies
* Poor early stage detection rates= low survival rates
* Tumors grow and spread rapidly and are often bilateral
Ovarian Cancer Risk Factors: * Family history of ovarian cancer
* History of breast, bowel, or endometrial cancer
* Nulliparity
* Infertility
* History of dysmenorrhea or heavy bleeding
* Diets high in animal fat
* Age older than 40- peaks at age 50-55
Ovarian cancer symptoms: * abdominal pain or swelling; dyspepsia, indigestion, gas
* Hx of: ovarian imbalance AEB premenstrual tension, heavy menstrual flow, or dysfunctional bleeding
* The only sign may be an abdominal mass- may not be identifiable until size reaches 6 inches
* Pap only abnormal in 20-30%
* CA-125 may be elevated (not diagnostic- used to eval progress)
* USG and CT can be diagnostic tools
* Exploratory laparotomy used to dx and stage tumors
Treatment of Ovarian Cancer: * Similar to cervical cancer
* Tx depends on stage of cancer
* Chemotherapy
* Radiation
* Surgery
Breast Cancer: * Early detection is paramount to successful treatment
* If cancer is localized without metastasis, clinical cure rate 75-90%
* When axillary lymph nodes are involved, 5year survival rate 40-50% & 10year rate only 25%
Early detection methods
* Self breast exam needs to be done monthly in women over 20
* Mammography- begin age 40, then annually
* Yearly clinical breast exam- assess for symmetry and size, contour, skin changes (color, texture, venous patterns), nipple changes, and lesions; also assess axillary lymph nodes
Assessment of Breast Cancer: * Note location of mass (in clock face method), shape, size, consistency, and fixation to surrounding tissues
* Skin changes: peau dÂ’ orange (dimpling or orange peel appearance), increased vascularity, nipple retraction or ulceration
* Psychosocial: fear of cancer; threats to body image, sexuality, intimate relationships, and survival; and decisional conflict about treatment
Treatment of Breast Cancer: * Nonsurgical (rarely done alone, except in inoperable cases): chemotherapy, radiation
* Surgical
1. Lumpectomy: local excision and resection
2. Partial mastectomy: removal of portion of breast that contains the tumor
3. Modified radical mastectomy: entire affected breast is removed (pectoral muscles and nerves left intact)
Benign Prostatic Hypertrophy: * Occurs in almost all men with aging
* Prostate tissue begins to have abnormal increase in number of cells which leads to enlargement of the gland
* Leads to narrowing of prostatic urethral channel
Symptoms of BPH: * Urinary frequency
* Nocturia
* Urinary hesitancy
* Hematuria
* Diminished force of urinary stream
* Post-void dribbling
* Bladder distention
* Possible renal insufficiency (edema, pallor, pruritis)
* Uniform, elastic, nontender palpable prostate
BPH Laboratory assessment: * CBC (infection or anemia)
* BUN & serum creatinine (eval renal function)
* Prostate specific antigen (PSA) to rule out malignancy
* Flowmetry- evaluates flow rate and residual urine
BPH Interventions: * Nonsurgical measures that minimize obstructive symptoms, by causing a release of prostatic fluid (prostatic massage, frequent sexual intercourse, and masturbation)
* Avoid large amounts of fluid in a short time
* Avoid alcohol, caffeine, and diuretics
* Void as soon as urge is felt
***Prevent overdistention of bladder, which leads to loss of tone
***Avoid meds that cause urinary retention: anticholinergics, antihistamines, and decongestants
Operative interventions
* Most common is transurethral resection of the prostate (TURP) to relieve obstruction caused by hypertrophy- only removes part of the enlarged prostate
Prostate Cancer: * Most common cancer among American men; second leading cause of cancer deaths in this population
* Screening is done with digital rectal exam (DRE) and PSA--annually after age 50
* If at risk (prostate CA in 1st degree relative or African American), need screening earlier
* DRE yields hard, irregular prostate
PSA: * Immunogenic glycoprotein secreted by the prostate
* Normal level is 4ng/mL
* Levels can be increased by prostate CA, BPH, prostatic infarction, and prostatitis
* PSA needs to be done in combination with DRE (25% of men with prostate CA have normal PSA)
Menarche: First menstrual period
Average age of onset 12 to 13 years old
Can range from 9-17 years old and still be within normal limits
Often anovulatory
Prostate Cancer screening: * Transrectal USG
* If malignancy suspected, need biopsy
* After dx made, need CT of pelvis to assess nodes
* Bone scan can determine metastasis
* Most pts with prostate CA have elevated serum acid phosphatase; and elevated serum alkaline phosphatase if mets to bone
Prostate Cancer Interventions: * Many similar to BPH
* Advanced cases require pelvic lymphadenectomy
* Radical Prostatectomy- removal of prostate gland, prostatic capsule, the cuff at the bladder neck, seminal vesicles, and regional lymph nodes
Radical Prostatectomy: * Patient is sterile, but ability to have erection and orgasm shouldnÂ’t be permanently impaired
* May have erectile dysfunction if damage is done to pudendal nerve during surgery
* Urinary incontinence possible complication- need to learn perineal strengthening exercises after surgery and removal of foley
Prostate Cancer treatments: * Chemotherapy
* Radiation
* Hormonal therapies- can be accomplished by bilateral testicle removal, administering estrogens, or Depo-Provera
Erectile Dysfunction: * Inability to maintain an erection for sexual intercourse
* Can be organic or functional
Organic ED: * Gradual deterioration of function- first diminishing firmness, then decrease in frequency of erections
* Multiple causes: inflammation of prostate, urethra, or seminal vesicles; prostate surgeries; pelvic fx; HTN; DM; thyroid dysfunction; smoking; ETOH; certain medications
Functional ED: * Psychologic cause
* Have normal nocturnal and morning erections
* Usually precipitated by stress
ED Pharmacologic Treatment: Viagra can be used to treat both types of ED
-take the pill 1 hour before intercourse
-need stimulation to achieve erection
-must abstain from alcohol- can impair erectile ability
-common SE: HA, facial flushing, diarrhea
-men taking nitrates cannot take Viagra because of vasodilatation effects
Testicular Cancer: * Most common malignancy in men ages 15-35
* Risk is increased in men with undescended testes; having a brother or close male relative with testicular CA; hx of testicular trauma or infection
* Testicular CA rarely bilateral- if it is, usually metastatic
* Early detection aided by self exam
Diagnostic Assessment
* Primary tumor markers are alpha-fetoprotein and hCG
* Benign testicular tumors NEVER cause an increase in these markers
Patient education
* May wish to store sperm in sperm bank to preserve for future use
* Insurance may cover these expenses
* Also need counseling regarding anxiety and body image disturbances
* May be candidate for silicone prosthesis
* Need monthly TSE on remaining testicle
Estrogens inhibit the release of LH from the pituitary: *

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Number of cards 41