M02 - DISORDERS OF THE REPRODUCTIVE SYSTEM (GYNECOLOGIC NURSING)

GYNECOLOGIC e. Uterus gets smaller and firm

- Derived from Greek words “gyne” or “gyneikos” meaning f. Ovaries become small, firm and atrophic
woman / female and “logia” meaning study. g. Breasts lose fullness and reveals atrophy and
- Gynecology = study of diseases of women shrinkage

GYNECOLOGY OF INFANCY & CHILDHOOD 3. SUBJECTIVE SYMPTOMS

o The concept of gynecology includes developmental A. Hot Flushes
defects, anomalies and diseases of the reproductive o Especially at night due to vasomotor phenomena
organs in females of all ages from infants à elderly limited to the upper part of the thorax, head &
woman. neck
o This broadened concept acknowledges equal rights for o Usually followed by redness of the skin &
young and old alike, especially as applied to preventive perspiration
and therapeutic aspects o May be controlled by the use of estrogen,
o Pelvic evaluation at an early age may not only be desirable sedatives or both
but in some cases, may be a necessity B. MENOPAUSAL DYSPAREUNIA
o Due to thinning of the vaginal mucosa and
CONSIDERATIONS IN THE GYNECOLOGICAL EXAM IN decreased function of the mucus secreting
CHILDHOOD cervix and Bartholin’s glands
1. Anatomical consideration places emphasis on the infantile
of small size of the reproductive organs
2. Special techniques may be required because of the C. UNNECESSARY FEARS & BAFFLED THOUGHTS
immaturity of the reproductive organs
3. The exam may have possible emotional effect, both NURSING PRINCIPLES
immediate and in the future. Parental reactions have much 1. History Taking
to do with this. a. Menstrual Cycle
4. The nurse should have patience, reassurance and avoid b. Marital and Sexual History
things that will likely cause pain. c. Obstetrical History
d. Previous Surgeries / Illness
GYNECOLOGIC GERIATRICS e. Bowen and Urinary Assessment
- Refers to changes in the reproductive organs due to aging f. Associated Organs Review
1. MENOPAUSE g. Presenting Problem
- cessation of menstruation, “change in life” or grand
climacteric 2. Provision of Privacy
- Average age for the onset of peri-menopausal transition is 3. Prevention of Infection: use of sterile equipment for pelvic
46 years old exam
- Average duration is 5 years 4. Physical Preparation
- Cigarette smoking and a history of intermenstrual intervals - Position & Draping
decrease the age of onset of menopause 5. Psychological Preparation
q PERIMENOPAUSE – period that encompasses the a. Normally, women associate these organs with femininity
transition from normal ovulation cycle to cessation of aside from reproductive function and sexual symbolism
menses; marked by irregular menstrual cycles b. Women may experience difficulty accepting manipulation
q CLIMACTERIC PERIOD – Signals the period when a of these organs curing tests and treatments
woman moves from the reproductive stage of life c. The nurse who is sensitive to the many thoughts and fears,
through the perimenopausal transition, menopause to feelings of humiliation and guilt, embarrassment and anger
the post menopausal years that may trouble the patient better prepared to help her
q MENOPAUSE – complete cessation of menses and is accept the necessary medical exam
a single physiologic event said to occur when a d. It often reassures the patient that medical information will
woman had not had a menstrual flow or spotting for 1 be given only to the doctor and goes no further
year. The woman’s cycle becomes irregular a skip or e. The patient should know that complete, frank answers to
miss periods the questions of the doctor will help considerably in
q POST-MENOPAUSE – the time after menopause, determining the cause of any difficulty in planning suitable
when the woman has shorter or lighter periods, treatment
longer or heavier period and have a lot of clots f. The woman should be prepared for the questions she will
be asked like monthly periods, pregnancies, deliveries, etc.
2. PHYSICAL CHANGES g. She should be given a chance to think through her answers
a. Gradual atrophy of the reproductive tract under less pressure and thus give more accurate
b. Vulva loses contour and tumescence information
c. Labia shrinks h. Explain to the patient the procedure that will be performed
d. Vaginal mucosa becomes thinner and smooth what she is expected to do and what the doctor will do
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 i. A calm, thoughtful, interested, yet matter of fact manner Class 5: cytology is conclusive of
often helps patient to be at ease. The nurse should Ca
however appraise each patient and adjust her approach
accordingly. NOTE: Class 1-4 additional
j. Reassure the patient that the nurse will be present during diagnostic exam; biopsy and D&D
the entire procedure
k. Ventilation sessions may provide the nurse an opportunity C. CERVICAL BIOPSY AND CAUTERIZATION
to clarify misconception that the patient may have. Some • Removal of small bits of tissue from the cervix for
examples are: diagnostic purposes. Electrocauterization is done
ü Removal of uterus means induction of menopause afterwards to control bleeding from the site or to
ü A radical hysterectomy (w/o vaginoanatomy) remove additional tissue
means that one’s sexual life is terminated • Post Biopsy Instructions:
ü Removal of the reproductive organs make a q Avoid heavy work for 24 hours
woman less womanly q Avoid heavy lifting
ü Removal of the ovary produces sterility q Cervical packing remains in place and removed
ü Suspicious Pap’s Smear positively establishes the after 24 hours
diagnosis of malignancy q Sexual activity is resumed with doctor’s order
l. Every effort to maintain the patient’s privacy, to understand usually 2-3 weeks after
her emotional liability and to listen to her expression of q Complete epithelialization is expected in 2-3
needs must continue months
q Increase in vaginal secretions is expected for 2-3
GYNECOLOGIC PROCEDURES days
1. DIAGNOSTIC
A. SCHILLER’S TEST: for Ca D. CULDOSCOPY
• Cervix is painted with tincture of iodine • Visualization of the internal reproductive organs by
• Color change in the cervix is noted inserting a tubular lighted instrument (culdoscope)
» Mahogany Brown Stain: (-) negative result through an incision made in the posterior fornix of the
» No Staining: (+) positive result vagina into the cul-de-sac of Douglas
B. PAPANICOLAU TEST • Preparations: Knee Chest
USES: To detect precancerous lesions • Home Care Instructions:
To detect recurrence of Ca q No douches and sexual activity for 1 week
To evaluate endometrial status q Watch out for complications like infection,
SUBJECTS: Women >20 years old hemorrhage and air embolism
Sexually active women – done q The incision should heal rapidly
regularly
PREPARATIONS: No sexual activity during E. LAPAROSCOPY
preceding 24 hours • Abdomen is insufflated with CO2 and a trocar is
No lubricant used introduced through the lower portion of the umbilicus
No vaginal tablets for 2-3 nights • A laparoscope is inserted and pelvic organs are visualized
before • This is a diagnostic aid to determine ectopic pregnancy,
No perineal douche before the inflammatory disease and ovarian neoplasms
exam
PROCEDURE: Aspirate or swab vaginal secretions F. HYSTERO-SALPINGOGRAM
from the posterior fornix and make • X-ray study of the uterus and the fallopian tubes after the
a smear on the glass with light injection of a contrast medium through the cervix via a
rolling motion. DO not let smear cannula (indigo-carmine dye)
become dry, immerse immediately • Purposes:
in a fixing solution of ethanol 95%. q Study problems of sterility
RESULT: Has 90-95% accuracy for cervical q Evaluate tubal patency
Ca q Determine the presence of uterine pathology
70-75% accuracy for severe q Position: Lithotomy
dysplasia q Result: If tubes are patent, the dye can be visualized
80# accuracy for endometrial Ca passing out the fimbriated end of the fallopian tubes

Class 1: absence of atypical or G. RUBIN’S TEST

abnormal cells • Determine tubal patency, CO2 is passed through the cervix
Class 2: atypical cytology but no into the uterus and tubes.
evidence of malignancy • If patent, gas will pass through the fimbriated ends of the
Class 3: cytology suggestive but fallopian tubes into the peritoneal cavity and will give a
not conclusive of malignancy sensation of fullness and spasmodic shoulder pains due to
Class 4: cytology strongly suggests severe irritation from the gas
Ca
H. SIM’S-HUNNER’S TEST

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 • Post-coital exam: a specimen of seminal fluid from
posterior fornix and cervical canal is aspirated 2-4 hours does not accelerate with
after coitus fetal movement
• PURPOSE: Test for compatibility of sperms with cervical
mucus. Determine the husband’s ability to deposit normal
motile sperms in sufficient amount
I. SEMEN ANALYSIS
• Examination of the semen for number and motility
J. ULTRASOUND
• Simple, safe and inexpensive procedure which causes or A.
uses sound waves of a transducer and scan oscilloscope
• Purpose: To determine tumor or cysts or retroperitoneal
masses
• Limitation: Technical difficulty in fat or obese patients could
be altered by none or gas interference
K. COMPUTERIZED TOMOGRAPHY
• Instead of just a single x-ray source and film, there is an x-
ray source moving around the patient with special
detectors opposite the x-ray source
• The computer translates the x-ray film taken on the patent
and projects it on the HIV screen
(+) Non-Reactive: FHR
GYNECOLOGIC DISORDERS
MENTRUAL DYSTUNCTIONS
AMENORRHEA – absence of menstruation anytime between
puberty and menopause (not a disease but a symptom)
1. Primary – failure of menstruation to appear initially at
puberty
2. Secondary – cessation of menstruation after menarche
• Circumstances accompanying amenorrhea
a. Absence of both menarche and secondary
sexual characteristics by the age of 14
b. Absence of menses by age 16 regardless of the
presence of normal growth and development
c. 3-6 months absence of a periods or
menstruation

INDIRECT FHR MONITORING • CAUSES

- Involves placing an instrument on the pregnant abdomen § Defect of interruption in the hypothalamic -
that FHR through uterine and abdominal wall pituitary-ovarian-uterine axis
- Simple and can be used before the membranes rupture or § Anatomic abnormalities
if cervix is dilated § Other endocrine disorders - Hypo or
- Instruments used: hyperthyroidism
ü Head Stethoscope § DM
ü Ultrasound Stethoscope – Doppler Principle § Medications
§ Eating disorders
DIRECT FHR MONITORING § Strenuous exercises
- By fetal electrocardiography: presenting part after § HIV/ AIDS
membranes rupture § Emotional stress
- Risk: scalp abscess, postpartum endometritis § Major psychiatric disorders
- Decelerations: transient fall of FHR § Malnutrition
Early, normal, occurs during contractions
negative • MANAGEMENT
Late, abnormal, 30-40 seconds after each contraction = utero 1. Counselling and Education on how to deal with
positive placental insufficiency stress
Variable cord compression 2. Deep breathing exercises and relaxation
techniques
3. Biofeedback and massage therapy
NON-STRESS TEST STRESS TEST 4. Daily calcium intake of 1200-1500 mg/day –
1. Nipple Stimulation Stress Test drinking 3 glasses of skimmed milk
2. Oxytocin Challenge Test (OCT): • BIOFEEDBACK
FHR increases in response
Oxytocin infused per IV with 1 m.u. § A mind-body technique that involves using
to fetal movement, uses
initially and increased every 5-15 visual or auditory feedback to gain control
external fetal monitor
minutes until 3 contractions are over involuntary bodily functions
experienced in 10 minutes § This may include gaining voluntary control
Indicated for: over such thing as heart rate, muscle
Diabetes mellitus tension, blood flow, pain percenption and
Toxemia blood pressure
IUGR
Post Term B. PHYSIOLOGIC AMENORRHEA – normal absence
Rh Incompatibility before puberty, during pregnancy, lactation and
Results: Results: menopause
(-) Reactive: FHR (-) Reactive: No late decelerations
C. CRYPTOMENORRHEA – reduction in frequency of
accelerates in response to (+) Non-Reactive: Consistent &
menstruation or prolongation of interval abnormally,
movement persistent late decelerations
usually from 38 days to 38 months

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 D. POLYMENORRHEA – interval is shortened or more
frequent occurrence of menses usually every 20 days
E. HYPOMENORRHEA – scanty Menstrual flow without
relation to frequency
F. OLIGOMENORRHEA – a decreased menstruation
either in amount, time or. both
G. HYPERMENORRHEA – or MENORRHAGIA – excessive
menstrual flow
H. METRORRHAGIA – bleeding or spotting without
obvious relation to menstrual cycle. Also known as
intermenstrual bleeding
I. DYSMENORRHEA – painful menstruation with spastic crampy
and congestive pains located in the supra-pubic area or lower
abdomen
Þ Types
PRIMARY DYSMENORRHEA
- onset of pain early in menstrual life with inherent or
congenital causes, 2 years after menarche
ASSOCIATED WITH:
Increased uterine activity
Myometrial contractions induced by prostaglandin in the second
half of the cycle
Pain at the start of flow and lasts for 8-48 hours
SYMPTOMS:
Backache, weakness, sweating, Nausea and Vomiting, Diarrhea,
Dizziness, Headache
MANAGEMENT:
Heating pads, massage of lower back, hot baths, soft rhythmic
rubbing of the abdomen, guided imagery, yoga, meditation,
progressive relaxation, repositioning, Medications, Exercise and
less salt and sugar intake 7-10 days before menses
SECONDARY DYSMENORRHEA
onset of pain several years after menarche
ASSOCIATED WITH:
Pelvic pathologies as adenomyosis, endometriosis, PID,
Endometrial polyps, Submucous interstitial myomas
SYMPTOMS:
Pain characterized by dull, lower abdominal aching radiating to
the back or thighs accompanied by feelings of bloatness and
pelvic fullness
PREMENSTRUAL SYNDROME
A complex, poorly understood condition that includes a number
of cyclical physical and behavioral symptoms occurring in the
luteal phase of menstrual cycle
SYMPTOMS:
Fluid Retention (Bloating, edema, pelvic fullness, breast
tenderness, weight gain) and Behavioral and emotional changes,
depression, CRAVINGS, headache, fatigue and backache
MANAGEMENT:
Education and Proper nutrition, Yoga, medications – vit b6 and
calcium magnesium supplements, diuretics, prostaglandin
inhibitors, progesterone, OCP
MEMBRANOUS DYSMENORRHEA
caused by the removal of the endometrium as one piece instead
of breaking off or sloughing off. Also known as “endometrial cast”
ENDOMETRIOSIS
Painful reproductive and immunologic disorder in which tissue
implants resembling endometrium grow outside the uterus.
Implants respond to cyclic changes causing menstrual like
bleeding that leads to inflammation, scarring and adhesions in the
pelvic and abdominal cavities
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SYMPTOMS:
chronic non-cyclic pelvic pain (radiating to thighs) and heaviness,
diarrhea, pain with defecation, constipation
MANAGEMENT:
Suppression of ovulation, inducing artificial menopause, ablation
of lesions through laser or electodiathermy
• Diathermy – is electrically induced heat or the use
of high frequency electromagnetic currents as a
form of physical therapy and in surgical
procedures
CAUSES
A. PSYCHOGENIC- unstable nervous system or psychic
trauma, especially when related to menstrual period; lack
of knowledge about significance and normality of
menstrual functions.
B. CONSTITUTIONAL- results from disease conditions as
anemia, tuberculosis, DM, overwork or fatigue
C. OBSTRUCTIVE OR ANATOMICAL- caused by cervical
lesions, stenosis or acute anteflexion of the uterus
D. ENDOCRINE FACTORS- increased estrogen which is a
normal stimulant of uterine contractility
TREATMENT
A. Endocrine Therapy
1. Use of estrogen- in adequate dosage in early part of
the cycle to convert ovulatory cycle to unovulatory
(inhibition of ovulation brings about relief of pain)
2. Use of Progesterone- to suppress ovulation, the drug
is given during the first 25 days of the cycle
B. Pre-sacral neurectomy- gives complete relief of pain in
60-70% patient cases
C. Treatment during attacks:
1. Local use of heat
2. Analgesics
3. Antispasmodics
D. Psychotherapy
POSSIBLE CAUSES OF MENSTRUAL DYSFUNCTIONS
A. Neurogenic- organic lesion or idiopathic hypothalamic
dysfunction
B. Pituitary- insufficiency of hormones, tumors or congenital
defect
C. Psychogenic- minor or major symptoms
D. Chronic illness
E. Metabolic diseases of the pancreas, thyroid and adrenalin
F. Nutritional disturbances like malnutrition
G. Ovarian- as in tumors or congenital defects
H. Congenital causes- like imperforate hymen, absence of
vaginal septum (gynatresia)
I. Traumatic- like stenosis or vagina or cervix due to trauma
GENERAL METHODS OF TREATMENT
Each patient must be treated according to etiologic factors
A. Steroid Therapy- designed to trigger pituitary functions
B. Gonadotropic Therapy- designed to replace pituitary
hormones
C. Clomiphene Therapy- stimulate pituitary activity through
the hypothalamus
D. Hypothalamic hormone stimulation which directly stimulate
synthesis and release of pituitary gonadotropins (under
research)
E. Good nutrition
Page 4 of 8
 IDYSFUNCTIONAL UTERINE BLEEDING
- Abnormal bleeding from the uterine associated with tumor
and inflammations. It is apt to occur at the extremes of
menstrual life. Major cause is increase in endometrial lining
of the uterus or endometrial hyperplasia.
UNOVULATORY BLEEDING
- Follicle develops but instead of maturation becomes cystic
and then degenerates.
ABNORMAL MENSTRUATION
1. Precocious - appearance of menarche early in childhood,
usually under 9 years of age, usually passages, GI mucous
membranes, breasts. There is a question whether they can be
really called as menstruation. M. UTERINE DISPLACEMENTS
1. ANTEFLEXION - bending forward of the body of the
ANOMALIES AND MALFORMATIONS OF THE uterus usually seen in a small underdeveloped organ
REPRODUCTIVE ORGANS • Cause: Gonadal deficiency
Genital Anomalies • Cues:
A. VARIATION IN SIZE OF THE LABIA MINORA- one labium » Crampy dysmenorrheal
is larger than the other » Sterility
» Delayed menarche
• Management: Stimulation of growth of the
uterus, dilation of cervical canal and curettage

2. RETRODISPLACEMENTS- backward displacement of the

B. AGGLUTINATION OF THE LABIA- labia minora and labia uterus
majora are held together in the midline by dense Types:
adhesions a. Retroversion- uterus is tilted backwards on its
C. IMPERFORATE HYMEN- absence of hymenal opening. transverse axis a greater or less degree with
This is usually treated with excision of the hymen, under forward rotation of the cervix
general anesthesia b. Retroflexion- backward bending if the uterus
D. RIGID HYMEN- the hymenal opening is normal, but the with the cervix in usual position
membrane is usually firm giving rise to dyspareunia c. Retrocession- backward bending of the
E. CONGENITAL ABSENCE OF VAGINA- usually associated uterus without rotation or bending
with the absence of the uterus and with anomalies of the
urinary tract. Also termed “agenesis of the vagina”
F. VAGINAL ANUS OR “ATRESIA ANI VAGINALIS- anus and
the bowels open in to the vagina. Surgical correction is
necessary
G. ABSENCE OF UTERUS- occurs with absence of vagina
H. DOUBLE OR SEPTATE VAGINA- vaginal canal is
separated into two by a septum. May occur with entirely
normal uterus and fallopian tube. It is generally
asymptomatic until marriage when it is found to cause
dyspaneuria. Excision of the septum is done.
I. INFANTILE UTERUS- presence of immature uterus
J. UNICORNUATE UTERUS- uterus has only one horn or Causes:
opening into the fallopian tube caused by the a. Congenital- observed in uterus of very young
development of only one Mullerian tube. Ability to girls
conceive depends upon the maturity of the unicornuate b. Acquired
uterus » Puerperal - due to increased strain on
K. BICORNUATE UTERUS- the upper portion of fundus of the supporting ligaments that when the
uterus is divided into two separate horns, the lower portion uterus involutes, the overstretched
fused to form only one cervix ligaments can no longer maintain it in
L. UTERUS DIDELPHYS- or double uterus- cervix and vagina normal position
due to the presence of a complete septum in the midline
» Adrenal Diseases - like inflammatory or
endometrioses
» Neoplasms - as in large uterine myomas
which push the uterus backwards or in
ovarian tumor located over the uterine
body
» Trauma as in sudden falls
» Full bladder and rectum
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 » Intra-abdominal pressure 1. Vaginal Hysterectomy: Suitable for almost massive degree of
» Increased pelvic tilt prolapsed
» Variation in length of vaginal walls 2. Manchester Operation: Done for lesser degree of prolapsed
especially those associated with large cystocoele. This involves
CUES cervical amputation.
a. Backache 3. Colpocleisis (Le fort operation): Closing the vagina in occasional
b. Dysmenorrhea cases of massive procedentia. This is performed only in the
c. Fatigue elderly or widow. Preceded by vaginal hysterectomy. Usually
d. Bladder irritation done as a last resort.
e. Constipation
TREATMENT B. Non-Surgical
a. Postural - knee-chest position which causes air to 1. Pessary Treatment: Made of plastic, soft, hand rubber coming in
distend the vagina to allow the freely movable uterus different shapes to fit the needs of the patient
to fall towards the front. Binomial position and o Care Prior to use:
maintained afterwards with a pessary » Wash with soap and water, soak in
b. Surgical - shortening of the round and sacrouterine antiseptic solution for one hour.
ligaments » Doctor should assess patient before
insertion
3. PROLAPSE OF THE UTERUS - more frequently found in o Care During its use:
elderly women than young ones » The patient must be aware that it causes
CUES increase vaginal discharge and
• Discomfort due to mechanical protrusion of the uterus asymptomatic irritation
• Some degree of bearing down and heaviness of the » Daily cleansing vaginal douche is
lower abdomen required
• Backache due to traction of the uterine ligaments - The patient should return to the doctor after
• Urinary incontinence one week for re-evaluation. If found fit, the
• Pelvic Drag doctor will let her patient wear it
• Constipation continuously and tell her to return again for
• General Fatigue regular check-up.
CAUSE: - In elderly woman, when operation is not
a. Increasing laxity and atony of muscular structures in later feasible, use of pessary may be desirable for
life an indefinite period of time
b. Over-stretching of the pelvic floor especially of the - In young woman, use of pessary usually in a
cardinal ligaments which causes vaginal relaxation? temporary measure.
o Types of pessary:
TYPES: » Hard rubber ring
a. First degree- When the cervix of the uterus points in the » Soft rubber ring
axis of the vagina
» Hard rubber cup
b. Second degree - The cervix is at or near the Introitus
» Menge’s pessary
c. Third degree - “Procedentia Uteri”, cervix protruses
» Glass ball
well beyond the vaginal surface

CUES:
a. Discomfort due to mechanical protrusion of the uterus
b. Some degree of bearing down and heaviness in the
lower abdomen and backache due to traction on the
uterine ligaments as well as venous congestion
produced by the prolapsed
c. Urinary incontinence
d. Pelvic drag
e. Constipation
f. General fatigue

Treatment will depend upon on:

a. Age
2. Vaginal packing — occasionally it used to give temporary relief in
b. Mental Status
cases of uterine collapse
c. General Health
d. Degree of Prolapsed
Associated anomalies with prolapse:
e. Presence of Absence of associated pathological conditions
a. Cystocosys — occurs as a result of a defect in the cubocervical
fiscial plane which supports the bladder anteriorly and tends to
TREATMENT
permit the bladder to sag down and beyond the uterus and
A. Surgical
sometimes out of vagina

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b. Rectocoole — results from similar mechanism involving the
pararectal fascia with a deep posterior fascia which may be
drown farther downward along the anterior surface of the
rectum
TREATMENT
Colpoperineorrhaphy
» Anterior — for cystocoele
» Posterior — for rectocoele
HERMAPHRODITISM
There is a combined existence of the same male and female sex
organs in the same person associated with malformation of the
reproductive organs
1. PSEUDOHERMAPHRODITISM — most common type
A. Female — essential sex glands are the ovaries but the
external genitalia resemble that of the male due to
abnormal development. Clitoris is hypertrophied and
looks like make penis, secondary sex characteristics and
mental attitude is that of the male.
B. Male — more frequent essential sex organs and the
testes but the secondary sex characteristics and attitude
are that of the female
The true sex cannot be easily determined except through a nuclear
sex chromatin pattern observed in the smear of cells taken from the
epithelium of the mouth, vagina or skin stained by the Pap’s smear
technique.
2. HERMAPHRODITISM — combined existence in the same
person of both the male and female sex glands commonly
associated with malformation of the reproductive organs
A. Masculinizing influence - hypertrophied clitoris,
masculine distribution of body hair, masculine type of body
configuration and low voices
B. Feminizing characteristics — rudimentary vagina and
uterus and presence of ovarian tissue. This is rare
INFERTILITY
inability to achieve pregnancy within a stipulated period of time
usually one year
a. Primary — the couple has never produced an offspring or has
never conceive
b. Relative or secondary — inability to conceive following the birth
of a child or difficult in achieving another pregnancy after a
previous conception
c. Absolute — pregnancy is forever impossible
STERILITY
term used only for individual who has some absolute factor
preventing procreation
» 6. Rubin’s test to check for tubal patency
FACTORS NECESSARY FOR NORMAL CONCEPTION TO TAKE
PLACE
1. The ovaries must produce at regular intervals normal ova
and hormone in sufficient quantity to foster implantation
2. The female reproductive tract must be patent and normally
formed
3. The testes of the male should be producing healthy sperms
of sufficient amount and motility for the fertilization of the
ovum
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4. The sperms should be deposited near enough to the
cervical canal so that they transverse the uterine canal to
meet the ovum
5. Both the male and female must be in good healthy
condition
SPERM ANALYSIS
The sperm can be examined on the basis of :
1. Quality in terms of content
2. Ease at which conception is attained
Quality is good if:
• Volume per ejaculation – 3 to 5 ml
• Number of sperms per ml – 60 to 120 million
• 60-80% are actively motile at two hour interval
• 85% sperm cells per ejaculation are normal in form
Etiology
CAUSES IN THE MALE (40%)
1. Infection which may obliterate the main sex ducts
2. Trauma or Injury – which may close the ducts
3. Toxic conditions – which may devitalize the germ cell
4. Severe illness – leading to physical exhaustion and
impotence
5. Insufficient sperm count – caused by:
a. Disease like orchitis – a complication of mumps
b. Anomalies of reproductive tract
c. Idiopathic tubular atrophy – leading to azospermia
6. Impotence and premature of ejaculation
7. Accidental
CAUSES IN FEMALE (60%)
1. Infection like endometritis which may obstruct the tubes
2. Immaturity of the reproductive organs
3. Anomalies of the reproductive organs like
a. Imperforate hymen
b. Absence of vagina
c. Tumors
4. Uterine displacement
5. General debility like renal and cardiac disease
6. Disturbed endocrine functions
7. Faulty diet – vitamin C and E
Diagnosis:
1. Through history including marital history
2. Complete physical exam of both husband and wife
3. Assessment of ovulation
a. BBT
b. Spinnbarkeit
4. Urine test for adequate levels of pituitary gonadotropins
(FSH and estriol)
5. Endometrial biopsy done on the 21st day of the menstrual
cycle to determine if secretory phase is occurring
7. Hysterosalphingogram
8. Sim’s Huhner’s test
9. Semen analysis – for quality and motility
Treatment:
1. Surgery
a. To release adhesions of ducts and reconstruction of
the ducts
b. To dilate stenosed ducts like the cervix
c. Tuboplasty — maintain patency of fallopian tubes
through insertion of polyethylene tubes into them
Page 7 of 8
 d. Artificial fimbriae — use of plastic like cap fitted at the
end of the tube
2. Alpha Amylase
3. Hormone therapy
§ clomiphene or clomid — stimulates the hypothalamus
to inactivate the pituitary gonadotropins made from
frozen diet human pituitaries

INFORMATION AND INFECTIOUS PROBLEMS

1. LEUKEMIA — any discharge from the vagina which is not bloody
§ Normal: during ovulation with a pH of 4.7 (acidic)
§ Abnormal: If copious in amount, malodorous with
abnormal color, cause irritation and redness of the vulva,
accompanied by burning sensation and frequent urination
with discomfort and pain in the lower abdominal region
CAUSE
• Foreign body
• Infection (gonorrhea, post-partal infection, moniliasis,
trichomonas, yeast)
• Cervical and uterine disease (polyps)
TREATMENT
• Vinegar douche or plain water (no strong acids or chemicals)
• Treatment of specific cause if diagnosed

2. PELVIC INFLAMMATORY DISEASE (PID) — ascending infection

after having involved the upper genital tract
CAUSES:
o Streptococcus, staphylococcus, and gonococcus
SYMPTOMS:
o Local — acute, sharp and severe pain of both
sides of the abdomen or pelvis aggravated by
defecation. Heavy, purulent discharge with foul
odor occurs.
o Systemic — general body malaise, fever and
chills, anorexia, vomiting and general aching
• infection spreads through blood, lymphatics and through
the genital tract

DISORDERS OF THE UTERUS AND OVARIES

1. CERVICAL POLYPS
• Benign tumors that hang on a stem-like pedicle and
protrude through the cervical os
• Associated with: Infection, chronic inflammation
• Symptoms: post coital bleeding, metrorrhagia,
menorrhagia and leukorrhea
2. UTERINE FIBROIDS/ LEIOMYOMATA – benign estrogen
responsive tumors of the uterine wall that regress with
menopause
3. OVERIAN CYSTS – either follicular or luteal depending on when
in the menstrual cycle the cysts develop

SUILLAN | SUNDIAM| TALASTAS | TANTISERANEE | TINAWIN | TOQUILAR | VENTURINA Page 8 of 8