Care of Clients with Problems of the Male Reproductive System

Nursing of Adults & Children I

Penis
-both a sexual organ & an organ for urination
-consists mainly of erectile tissue & urethra through which semen & urine are released via the meatus

Penis
-the meatus is in the glans penis
-the glans penis is the cone-shaped end of the penis
-the glans penis is enclosed by a fold of skin called the prepuce or foreskin (may be removed with
circumcision)

Scrotum
-sac that lies posterior to the penis
-protects the testes, the epididymis and the vas deferens in a space cooler than the abd cavity
-Left side normally hangs a bit lower than Right

Testes (testicles)
-produce testosterone & sperm

Epididymis
-1st portion of a ductal system that transports sperm from the testes to the urethra
-provides for storage, transport & maturation of sperm

Vas Deferens
-continues from the epididymis
-conveys sperm from the epididymis to the ejaculatory duct
Seminal Vesicles
-provides most of volume of ejaculate
-each vesicle joins with vas deferens to form the ejaculatory duct

Ejaculatory Ducts
-2 ducts that descend thru the prostate gland, ending in the prostatic
Prostate Gland
-surrounds the urethra at the base of the bladder
-produces an alkaline fld that forms part of the volume of the ejaculate

Prostate Gland
-prostatic fluid aids the passage of sperm & helps keep them alive
-prostatic fluid also helps protect the sperm from the acidity of the vagina
-ejaculate is emptied into the urethra

Urethra
-provides for passage of semen & urine through the meatus

Congenital Disorders
Phimosis
A condition in which the penile foreskin (prepuce) is constricted at the opening, making
retraction difficult or impossible
mMy be congenital or caused by edema or inflammation
Often associated with poor hygiene beneath the foreskin (SMEGMA)
Assessment
Edema
Erythema
Tenderness
Purulent Drainage

Medical Management
Antibiotics--systemic, local
Circumcision

Nursing Management
Patient/Parent teaching re: proper cleaning
Teaching re: pros & cons of circumcision

Hydrocele
A painless collection of clear yellow to amber fluid within the scrotum
Leads to scrotal swelling
Can be transilluminated, ruling out the presence of a mass
May be associated with infections, trauma, systemic infections (e.g., mumps)

TX
Usually no tx required unless there is compromised testicular circulation
pain embarrassment from increased scrotal size
Surgery involves I&D
Post-op care
Post-op complications

Varicocele
Varicose veins of the spermatic cord within the scrotum
Cause---Thought to be incompetent venous valves or obstruction of the gonadal vein

Clinical Manifestations
Can decrease sperm count and cause atrophy of the testicle, resulting in infertility
"Pulling" sensation, dull ache in scrotum
Pain in scrotum
Scrotal swelling

DX
Can be felt upon scrotal palpation (feels like a "bag of worms)
Ultrasound of scrotum

Medical Management
Usually treated in younger pts (to prevent infertility) and in pts with pain
Spermatic vein ligation
Post Op--
-ice pack 12 - 24 hrs (intermittent)
-wear a scrotal support

Epididymitis
Inflammation of the epididymis
Causes
-infection of the prostate**
-long term use of catheter
-prostatic surgery
-cystoscopic examination

Causes:
-trauma
-urinary tract infection
-chlamydia (most common cause in men under age 35)
**The causative organism passes upward thru the urethra & the ejaculatory duct, then
along the vas deferens to the epididymis

Clinical Manifestations/Assessment
Painful scrotal swelling
Pain along the inguinal canal & along the vas deferens
Reddened scrotum
Fever, chills
Pyuria, bacteriuria
Development of an abscess
"Duck waddle" walk

S/S DX
Increased WBC count
Nuclear med scan with injection of radioactive dye

Medical Management
Bedrest with scrotum elevated on towel to prevent traction on the spermatic cord, to facilitate venous
drainage, and to relieve pain (usually about 3-5 days)
Antibiotics
Intermittent ice packs/cold compresses may help decrease swelling & pain
**Avoid heat

Medical Management
Avoid lifting, straining, sexual excitement until infection completely resolved (may take
3 - 4 weeks)
Epididymectomy for recurrent/chronic epididymitis
Prostatitis
Inflammation of the prostate gland

Types:
-Abacterial
-can occur after a viral illness
-can occur after a sudden decrease in sexual activity, especially young males
-many times cause unknown

Types
-Bacterial
-usually associated with a lower UTI
-most common organism= E-coli

Clinical Manifestations
Abacterial
-urgency, frequency
-nocturia
-dysuria
-dull pain in perineum/rectal area back pain
-painful ejaculation

Clinical Manifestations
Bacterial
-same as Abacterial AND
-fever, chills
-urethral discharge upon prostate massage
-boggy, tender prostate

Complications
epididymitis
cystitis
decreased sexual functioning b/o pain

DX
HX of S/S
C&S of prostate fluid
Tender, swollen prostate upon palpation

Medical Management
Antibiotics---Carbenicillin (Geocillin)
Ciprofloxacin (Cipro)
Comfort Measures---sitz baths
analgesics
stool softeners
Medical Management
Pt Teaching
-FF to decrease chance of prostatitis causing UTI
-Importance of completing entire ABC regimen

Neoplastic Disorders
Benign Prostatic Hyperplasia (BPH)
(Benign Prostatic Hypertrophy)
An abnormal increase in the number of prostatic cells
NOT an increase in cell size
When the prostate enlarges, it extends upward, into the bladder, and inward

Benign Prostatic Hyperplasia (BPH)

Prostate is doughnut shaped gland that surrounds the urethra at the neck of the bladder
Approx 80% of men over age 50 have some sx of BPH
Cause ---unknown, but believed to be hormone related

Pathophys
Although androgen levels decrease with aging, the aging prostate appears to become
more sensitive to available androgen
The expanding tissue compresses surrounding tissue, narrowing the urethra

S/S
Urinary frequency
Nocturia
Hesitancy, decreased force of stream
Abd straining upon urination
Post-void dribbling
Sensation of incomplete emptying
Dysuria

S/S
Urinary retention (can be complete)
Bladder distention
S/S of UTI
Enlarged prostate (upon rectal exam)
S/S of hydroureter, hydronephrosis

Complications
UTI (upper & lower)
Hydroureter, Hydronephrosis
Urinary Calculi
Possibly renal failure
Epididymitis
Prostatitis

BPH--DX
HX of S/S
UA (bacteria, WBC, protein, blood)
Urine C&S
BUN, Creatinine
Cath for residual
IVP

BPH--DX
Cystoscopy
Rectal exam to palpate prostate
Prostate-specific antigen (PSA) to help r/o prostate cancer
Serum Acid Phosphatase
BX of prostate

Medical Management
Pharmacologic Management
-based on
-hyperplasic tissue is androgen dep
-muscle contractions of prostate can exacerbate urinary obstruction

Medical Management
Androgen deprivation with
-estrogen
-flutamide, Proscar (antiandrogens)
-meds shrink prostate tissue
-not usually very effective
Antibiotics to tx UTI, other infections
Catheterization for tx of retention

BPH---Medical Management
Release of prostatic fluid
-prostatic massage, frequent intercourse, masturbation

BPH---Medical Management
Prevention of overdistention of bladder
-avoid drinking large amount in short time
-avoid ETOH, diuretics, caffeine
-void as soon as urge felt
Avoid meds that can cause urinary retention
-anticholinergics, antihistamines, decongestants

BPH---Medical Management
Prostatectomy
-the enlarged portion of the prostate is removed ONLY
Indications for Surgery
Acute urinary retention
Chronic UTI b/o urinary residual
Hematuria
Hydronephrosis
Bladder neck obstruction sx such as extreme urinary frequency, nocturia

Type of Surgical Procedure

Depends on
-size of prostate
-location of enlargement
-whether surgery on the bladder is also needed
-pt’s age/physical condition

Transurethral Resection Prostatectomy (TURP) (Closed procedure)

-very common approach
-resectoscope inserted thru urethra & scrapes out the enlarged portion of the gland

Suprapubic Prostatectomy
-incision is made into the lower abd & bladder
-prostate removed thru the bladder
Retropubic Prostatectomy
-low abd incision made, bladder is retracted, & prostate is reached directly

Perineal Prostatectomy-
-prostate is removed thru a perineal incision between scrotum & rectum

Transurethral Incision of Prostate (TUIP)--small incisions made in prostate

-small incisions are made in the prostate to enlarge the prostatic urethra and relieve
obstruction
-often done as Out Pt procedure

Complications
Hemorrhage
Shock
Obstruction in lower UT with clots/swelling/stricture (with TURP)
Electrolyte imbalance
Thrombus/Embolus
Pain, bladder spasms
UTI, epididymitis

Nursing Care
Pre-Op
Post-Op
CBI maintenance/assessment
-use NS only
When cath removed
Discharge teaching

Cancer of Prostate
Causes
-exact cause unknown
-associated with
-genetic tendency
-late puberty
-multiple sexual partners
-high fertility
-hormonal factors

Associated with (cont’d)

-high fat diet
-chemical carcinogens
-viruses, STDs
usually very slow growing malignancy
usually metastasized to surrounding lymph nodes, bone, lungs, liver, kidney
Usually the younger the pt, the more aggressive the cancer

S/S
Sx of enlarged prostate
Complete urethral obstruction
Hematuria
Rectal obstruction, painful defecation
Late s/s---hip/back/pelvic bone pain

DX
Prostate exam
Prostate bx
PSA, Acid Phosphatase
US
Scans to detect mets

Medical Management
Tx depends on staging of disease
Total prostatectomy
-perineal or retropubic approach usually used
-Common complications--impotence
--incontinence

Medical Management
Radiation
Chemotherapy
Hormone Therapy (palliative)
-bilateral orchiectomy
-estrogen therapy

Nursing Management
Comparable to BPH
Important to teach re: impotence, incontinence

Cancer of Testes
3rd leading cause of cancer death in young men (20-35 years)
Neoplasm of usually 1 testis

S/S
Mass/lump on testicle (usually painless)
C/O heaviness in scrotum, inguinal area or low abdomen
Backache, abd pain from CA extension
Respiratory sx from mets (late)
Wt loss, weakness (late)

DX
H/O sx
Scrotum does not transilluminate
^ alpha-fetoprotein (AFP)
^ human chorionic gonadotropin (hcg)
Orchiectomy to remove the tumor & make positive dx (bx not suggested)
CT abd, chest (r/o mets)

Medical Management
Dependent on type/stage of disease
Unilateral orchiectomy
Radiation
Chemotherapy
Follow-up for lymph node exam & monitoring of AFP/HCG levels

Imp for pt to know that h/o testicular cancer increases chance for developing tumor on
other side
Sperm banking
TSE

Surgical Approaches
Prostate Gland
Penile Implant
Orchiectomy
Vasectomy
Nursing Management
 Care of clients with Female Reproductive Disorders

vulva
includes the external female structures, such as the mons pubis, labia majora and
labia minor (protective barriers for the softer internal structures) and clitoris (plays a role
in sexual arousal; analogous to the penis).

The Breasts
The breasts are also part of the external female reproductive system.•Their
external structure include the nipple, areola (darker area around the nipples) and
Montgomery tubercles (glands that produce a lubricant to keep the nipple soft and
supple)

Internal Female Structures

Vagina, Uterus, Cervix (lower portion of uterus), Fallopian tubes, Ovaries.

Common Diagnostic Tests:

Serum laboratory studies
–Luteinizing hormone (LH)
Stimulates progesterone secretion•Diminished levels may relate to prolonged,
heavy menses•Elevated levels may result in short, scanty menses.

–Follicle-stimulating hormone (FSH)

Stimulates estrogen secretion•Diminished level may relate to bleeding between
cycles. Elevated levels may result in excessive uterine bleeding.

Thyroid function tests

Used to roll out menstrual abnormality secondary to thyroid dysfunction–
Diminished thyroid hormone secretion may result in bleeding between cycles, irregular
menses, or absence of menstrual flow.

Adrenal function tests

Used to rule out menstrual abnormalities secondary to adrenal dysfunction–
Elevated or decreased production of adrenal cortex hormone secretion may result in a
amenorrhea.

Pelvic examination: to inspect and assess the external genitalia, perineal and anal
areas,introitus, vaginal tract & cervix

–Have patient empty bladder–Please patient in lithotomy position–Flex and abduct

patient’s thighs–Please patients feet in stirrups–Extends patients buttocks slightly beyond
the edge of the examining table
Laparoscopy: visualization of the pelvic structures with a lighted laparoscope inserted
through the abdominal wall•Culdoscopy: visualization of the ovaries, fallopian tubes, and
fallopian tubes, and uterus with a lighted instrument inserted through the vaginal tract
–After procedure, position patient on abdomen to expel air–Monitor for vaginal
bleeding–Instruct patient to abstain from intercourse, douching, and using tampons until
advised by physician

Colposcopy: visualization of the cervix with an instrument that magnifies

tissue•Papanicolau smear test (Pap smear): a sample of cervical scrapings is obtained for
study under a microscope for evidence of malignant cells changes.

–Right patient’s name on the frost side of the slide, handling edge is only–Smear the
specimen on the glass slide–Please drop of a fixative, dry, and send to laboratory–
Reinforced importance of Pap smears is recommended to the American Cancer Society

Common Diagnostic Tests:

•Cervical biopsy examination: removal of tissue to examine for presence of malignancy
–After procedure, advice patient to rest and avoid strenuous activity for 24 hours–Leave
packing in place until physician permits removal (usually 12 to 24 hours)–Monitor for
vaginal bleeding–Instruct patient to abstain from intercourse,douching, and use of
tampons until advised by physician–Explained that a malodorous discharge that may last
three weeks will occur, daily bath should help control this discharge

•Conization
–Removal of cone-shaped tissue of the cervix for analysis of cancerous cells–Indicated
for removal of diseased cervical tissue–

Nursing interventions
•Maintained packing 12 to 24 hours•Monitor for bleeding•Instruct patient to abstain from
intercourse, douching, and using tampons until advised by physician

•Schiller’s test
–Application of a dye to the cervix to aid in detecting cancerous cells–Normal vaginal
cells will stain a deep brown–Abnormal cells will not absorb the dye–Nursing
intervention: recommend to patient that a perineal pad be used to protect clothes from
stain.

•Ultrasonography
–A sound frequency that reflects an image of the pelvic structures–An aid in confirming
ovarian and uterine tumors

•Culture and sensitivity

–The culture of a specimen and exudate suspected of infection–The sensitivity of an
antibiotic to the microorganism
•Dilatation & curettage (D&C)
–A diagnostic and therapeutic procedure–The cervix is dilated to scrape the lining of the
uterine cavity with a curet.

–Nursing intervention:
•After procedure, provide sterile perineal pads and record amount of drainage•Encourage
avoiding to prevent urinary retention•Instruct patient to abstain from intercourse,
douching, and using tampons until advised by physician
•Mammography: an x-ray examination of the breasts to detect tumors; screening test is
dunned yearly for women over 40 years of age

•Thermography: infrared photography used to detect breast tumors•Xerography: an x-ray

examination of the breasts and skin that provides good definition of the tissue•CT, MRI

Inflammatory Disorders:
Pelvic Inflammatory Disease

•An inflammatory process involving pathogenic invasion of the fallopian tubes or ovaries
or both, as well as any vascular or supporting structures within the pelvis, except the
uterus.•Risk factors include multiple sexual partners, frequent intercourse, IUDs, and
childbirth.

•Symptoms include low-grade fever, pelvic pain, abdominal pain, a “bearing down
backache, foul-smelling vaginal discharge, nausea, etc.•Future infertility may develop as
complications

•Diagnostic tests and method: C&S, CBC, pelvic examination, laparoscopy•Treatment:

antibiotic therapy, analgesics•Nursing interventions
–Provide nonjudgmental, accepting attitude–Place patients in semi-Fowler’s position to
provide dependent pelvic drainage–Apply heat to abdominal area if ordered to improve
circulation and provide comfort

–Patient teaching should include the following:

•Take shower instead of tub bath•Perform perineal hygiene: wipe from front to
back•Learn how to recognize its sexual partner is infected with gonococcus: discharge
from penis of whitish fluid with painful urination (not all males are symptomatic)
.•Learned the importance of routine physical examination, because gonoccocal infection
is asymptomatic in the women•Reinforce safe sex guidelines

Inflammatory Disorders:
Endometriosis
•The growth of endometrial tissue, the normal lining of the uterus, outside of the uterus
within the pelvic cavity.•Most often occurs in women over 30 with familial history.•One
cause of female infertility.
•Pathology
–during menstrual period, endometrial cells are stimulated by ovarian hormone–Bleeding
into surrounding tissue occurs, causing inflammation–Condition may result in adhesions,
fusion of pelvic organs, bladder dysfunction, stricture of prowl, or sterility

•Signs and symptoms

–Subjective
•Discomforts of pelvic area before menses, becoming worse during menstrual flow, and
diminishing as flow ceases .•Dyspareunia•Fatigue
–Objective: infertility
•Diagnostic tests and methods

–Laparoscopy culdoscop

•Treatment
–Hormonal therapy to suppress ovulation–Surgical intervention: hysterectomy,
oophorectomy, or salpingectomy
•Nursing interventions
–Provide emotional support .–If patient is young, advised not to delay having a family
because of risk of sterility .–Explain that hormonal drugs may cause pseudo pregnancy
and irregular bleeding–If patient is middle-aged, advise her that menopause may stop
progression of condition

•Follow general post operative nursing actions, if the patient undergoes surgical
procedure
–Observe for vaginal hemorrhage, malodorous vaginal discharge, or vaginal discharge,
other than serosanguineous discharge–Observe for year-end retention, burning,
frequency, or urgency to void–Listen to renewed bowel sounds
•Provide patient teaching on discharge
–Heavy lifting, prolonged standing, walking, and sitting are contraindicated–Sexual
intercourse should be avoided until approved by physician

•Inflammation of the vaginal mucosal•Pathology:

–Invitation of virulent organisms permitted by changes in normal flora; pH becomes
alkaline–Causes:
•Trichomoniasis: parasitic organism•Candida albicans (moniliasis):fungal
organism•Atrophic (senile): occurs in postmenopausal women because of atrophy of
vaginal mucos

•bacterial: invasion by staphylococci, streptococci, E. coli, chlamydia, or gargnerella

vaginalis•Foreign body•Allergens or irritants
•Diagnostic tests, and methods: C &S, pelvic examination•Nursing interventions
–Reassure the patient during vaginal examination to decrease anxiety–Instruct patients on
perineal hygiene: cleansing front to back–In the event of trichomoniasis, instruct patient
to abstain from intercourse, or have partner wear a condom, because this infection can be
transmitted–Advice patient to use perineal pads because of increased discharge–Teach
patient importance of compliance with treatment]

•Ways to decrease risk of vaginitis include: –Wearing cotton-crotch underwear.–

Avoiding sitting in a wet bathing suit.–Seeking prompt medical attention at first sign of
infection.–Eating an 8-oz. container of yogurt with active cultures daily while taking
antibiotics.

oxic Shock Syndrome

•A condition most often associated with
Staphylococcus aureus,
which enters the bloodstream.•A strong relationship found between the use of tampons
during menstruation and the onset of TSS symptoms
•Symptoms include fever, vomiting, diarrhea, and progressive hypotension.•This woman
with toxic shock syndrome developed a flat, red, sunburnlike rash. This rash causes the
skin to peel 1-2 weeks after the illness

Fibrocystic Breast Disease

(FBD)
•Also called chronic mastitis or lumpy breast syndrome, it is the most common breast
lesion in females and usually occurs between ages 35 and 50. Many cases will subside
after menopause.
•Incidence of developing breast cancer is increased 3 to 4 times with FBD.•Pathology
–Cause is unknown; possible hormonal imbalance–Condition occurs during reproductive
years and disappears with menopause–A benign condition affecting 25% of women over
30 years of age
•Signs and symptoms
–Subjective: breast tenderness and pain–Objective: small, round, smooth nodules
•Diagnostic tests and methods
–Mammography, thermomastography, xerography
•Treatment: conservative
–Aspiration–Biopsy examination to rule out malignancy

•Nursing intervention
–Explain importance of monthly breast self-examination–Encourage patient to seek
medical evaluation if nodule forms, because cystic disease may interfere with early
diagnosis of breast malignancy

Malignant Neoplasms:
Breast Cancer
•Second major cause of cancer death among women. Statistics indicate that 1 in 10 will
develop cancer sometime during her life.•The key to cure is early detection by physical
examination, mammography, and breast self-examination.
•Signs and symptoms
–Subjective: nontender nodule–Objective:
•Enlarged axillary nodes•Nipple retraction or elevation•Skin dimpling•Nipple discharge
•Diagnostic tests and methods
–Mammography, thermography, xerography, breast biopsy examination

•Treatment
–Lumpectomy: removal of the lump and partial breast tissue; indicated for early
detection–Mastectomy
•Simple mastectomy: removal of breast•Modified radical mastectomy: removal of breast,
pectoralis minor, and some of an adjacent lymph nodes•Radical mastectomy: removal of
the breast, pectoral muscles, pectoral fascia, and nodes
–Oophorectomy, adrenalectomy, hypophysectomy to remove source of estrogen and the
hormones that stimulate the breast tissue–Radiation therapy to destroy malignant tissue–
Chemotherapeutic agents to shrink, retard, and destroy cancer growth–Corticosteroids,
antigens, and anti-estrogens to alter cancer that is dependent on hormonal environment

•Nursing intervention
–Provide atmosphere of acceptance, frequent patient contact, and encouragement in
illness adjustment–Encourage grooming activities–Arrange attractive environment–If the
patient is receiving radiation or chemotherapy, explain and assist with potential site
effects

–If the patient has undergone surgical intervention, follow post operative nursing actions
•Elevate affected arm above level of right atrium to prevent edema•Drawing blood or
administering parenteral fluids or taking blood pressure on affected arm is
contraindicated•Monitor dressing for hemorrhage, observed back for pooling of
blood•Empty Hemovac and measure drainage every 8 hours•Assess circulatory status of
affected limb•Measure upper arm and forearm, twice daily, to monitor edema•Encourage
exercises of the affected arm when approved by a physician; avoid abduction

–Patient teaching on discharge

•Exercise to tolerance•Sleep with arm elevated•Elevated arm several times daily•Avoid
injections, vaccinations, IV, and taking blood pressure, in affected arm

•Had a mother or sibling with breast cancer.•Never had children or had first child after
30.•Never breast fed.•Has a history of fibrocystic breast disease.•Started menstruating
before age 10.•Is obese.•Consumes high-fat diet and moderate amount of
alcohol.•Smokes.•Experienced a late menopause

Malignant Neoplasms:
Cervical Cancer
•The most preventable gynecological cancer, it is detected by Papanicolaou (Pap)
smear.•An abnormal Pap smear shows
dysplasia,
a change in the size and shape of the cervical cells.

•Signs and symptoms

–Subjective
•Asymptomatic in early stage•Menstrual disturbances•Postmenopausal bleeding•Bleeding
after intercourse•Watery discharge
–Objective: suspicious Pap test result
•Diagnostic tests and methods
–Pap smear–Cervical biopsy examination–Colposcopy–Schiller’s test–Conization
•Treatment
–Panhysterectomy–Radiation in advance case–chemotherapy
•Nursing interventions
–Reassure the patient and family that adjustment illness can be slow–Acknowledge that
the patient must adapt to illness, according to her age, developmental stage, and past life
experiences–If patient is to receive an internal radium implant:
•Provide isolation•Instruct a patient to maintain supine or side-lying position•Explaine to
the patient and visitors that the amount of time spent with patients will be limited to avoid
overexposure to radiation
•Provide high-protein, low residue diet to avoid straining of bowels•Maintain high fluid
intake: 2000 to 3000 mL daily•Insert Foley catheter to prevent bladder
distention•Administer antiemetics as ordered
–If the patient undergo surgery, followed general post operative nursing actions

Malignant Neoplasms:
Endometrial Cancer
•Postmenopausal women are at greatest risk, especially if they have taken estrogen
therapy for more than five years.•Cancer of the endometrium does not usually produce
symptoms until it becomes relatively advanced.
•The five-year survival rate for endometrial cancer is 84%.
•Signs and symptoms
–Subjective
•Postmenopausal bleeding•Bleeding between cycles•Bleeding after intercourse•Watery
vaginal discharge
–Objective
•Uterine enlargement•Suspicious Pap test results
•Diagnostic tests and methods: D & C, tissue biopsy examination

•Treatment
–Surgical intervention
•Panhysterectomy, oophorectomy, salpingectomy
–Chemotherapy–Radiation
•Nursing interventions: see cancer of the cervix

Malignant Neoplasms:
Ovarian Cancer
•Causes more deaths than any other gynecological cancer.•Incidence is greatest in women
between 45 and 65.
•Risks include nulliparity (never having borne a child), smoking, alcohol, infertility, and
high-fat diet.•Five year survival rate is 46%.
Menstrual Disorders:
Dysmenorrhea
•Painful menstruation, also called “menstrual cramps,” is more common in nulliparous
women and in women who are not having intercourse.•Cause: uterine spasms cause
cramping of the lower abdomen•Signs and symptoms
–Subjective: headache, backache, abdominal pain, chills, nausea–Objective: fever,
vomiting
•Treatment
–Analgesics, such as NSAIDs–Local application of heat–Pelvic exercises–D & C
•Nursing intervention
–Instruct patient on avoidance of fatigue and overexertion during menstrual period.–
Instruct patient on ingestion of warm beverages before onset of pain to prevent attack

Menstrual Disorders:
Amenorrhea
•Absence of menstruation. Can be primary or secondary.•Primary amenorrhea defined as
absence of menstruation by age of 17. Can be related to anatomical or genetic
abnormalities.•Secondary amenorrhea may result from anatomic abnormalities,
nutritional deficits (anorexia nervosa), excessive exercise, emotional disturbances,
endocrine dysfunction, side effects of medication, pregnancy, and lactation.

Premenstrual Syndrome (PMS)

•Experienced by one-third to one-half of women between 20 and 50.•Symptoms include
weight gain, irritability, mood swings, edema, headache, inability to concentrate, food
cravings, acne, and many others.•Can be alleviated by pharmacological interventions,
diet, and exercise.
Complications of Menopause
•Menopause, or climacteric, is the cessation of menstruation.•Some women experience
psychological responses, such as depression, nervousness, and insomnia.•Mild to
moderate periods of perspiration called hot flashes may occur.•May be treated by
pharmacological intervention, diet, and exercise

Structural Disorders
•
Cystocele
(a downward displacement of the bladder into the anterior vaginal wall).•
Urethrocele
(a downward displacement of the urethra into the vagina).
•
Retocele
(an anterior displacement of the rectum into the posterior vaginal wall).•
Prolapsed uterus
(a downward displacement of the uterus into the vagina).Risk factors for any and all of
above may include multiple pregnancies, third or fourth-degree lacerations with
childbirth, and weakening of pelvic muscles as an aging process.
•Nursing interventions (post-operative)
–Administer catheter care twice a day and PRN–Splint abdomen when coughing–Place in
low Fowler’s position or flat in bed to avoid pressure on suture line–Explain to the
patient that she should respond to bowel stimuli to avoid suture strain–After each bowel
movement, clean perineal area with warm water and soap; pat dry anterior to posterior–
Apply heat lamp, anesthetic spray, or ice packs in order to relieve discomfort

–Provide patient teaching

•Heavy lifting and prolonged standing, walking in sitting are contraindicated•Sexual
intercourse should be avoided until approved by physician•Perform pelvic exercises
Infertility
•May be related to anatomic or endocrine problems.•Diagnostic tests may include:–
Endometrial biopsy to detect tissue responses during both phases of menstrual cycle.–
Endocrine imbalance testing.–Laparoscopy to discover conditions such as endometriosis,
adhesions, or scar tissue.

Contraception
•Natural method: what is known as the “rhythm method.”•Barrier methods (male and
female condoms, the diaphragm, and the cervical cap) and spermicides.•Oral
contraceptives (the “pill”).•Norplant (six small progestin-filled pellets inserted under the
skin of the upper arm).•Depo-Provera (injected every 12 weeks).•Intrauterine Device
(IUD).•Sterilization (tubal ligation; vasectomy).