Y

Y

 


Y 


Diane R. Flores, RN, MAN

 

=
e ermina ion of a pregnancy by
e
removal or expulsion from
e u erus of a
fe us or embryo, resul ing in or caused by
i s dea
.
= An abor ion can occur spon aneously due
o complica ions during pregnancy or can
be induced, in
umans and o
er species
= orldwide 42 million abor ions are
es ima ed o ake place annually wi
22
million of
ese occurring safely and 20
million unsafely.
= 
ile ma ernal mor ali y seldom resul s
from safe abor ions, unsafe abor ions
resul in 70,000 dea
s and 5 million
disabili ies per year
= ne of
e main de erminan s of
e
availabili y of safe abor ions is
e legali y
of
e procedure.
= 40% of
e world's women are able o
access
erapeu ic and elec ive abor ions
wi
in ges a ional limi s.
  
 

= NTANE also known as miscarriage) is

e expulsion of an embryo or fe us due o
acciden al rauma or na ural causes before
approxima ely
e 22nd week of ges a ion;
e
defini ion by ges a ional age varies by coun ry.
= Mos miscarriages are due o incorrec
replica ion of c
romosomes
= A pregnancy
a ends before 37 weeks of
ges a ion resul ing in a liveborn infan is known
as a "prema ure bir
".
= 
en a fe us dies in u ero af er abou 22 weeks,
or during delivery, i is usually ermed
"s illborn".
= T
e mos common cause of spon aneous
abor ion during
e firs rimes er is
c
romosomal abnormali ies of
e
embryo/fe us, accoun ing for a leas 50% of
sampled early pregnancy losses.
= 
er causes include vascular disease suc
as
lupus), diabe es, o
er
ormonal problems,
infec ion, and abnormali ies of
e u erus.
= Advancing ma ernal age and a pa ien
is ory of
previous spon aneous abor ions are
e wo
leading fac ors associa ed wi
a grea er risk of
spon aneous abor ion.
= ND
ED ABRT N
= A pregnancy can be in en ionally abor ed in
many ways.
= T
e manner selec ed depends c
iefly upon
e
ges a ional age of
e embryo or fe us
= pecific procedures may also be selec ed due o
legali y, regional availabili y, and doc orpa ien
preference. Reasons for procuring induced
abor ions are ypically c
arac erized as ei
er
°

° 


°

= An abor ion is medically referred o as


w
en i is performed o:
= save
e life of
e pregnan woman;
= preserve
e woman's p
ysical or men al
eal
;
= ermina e pregnancy
a would resul in a c
ild
born wi
a congeni al disorder
a would be
fa al or associa ed wi
significan morbidi y;[
= selec ively reduce
e number of fe uses o
lessen
eal
risks associa ed wi
mul iple
pregnancy.
= An abor ion is referred o as



w
en i
is performed a
e reques of
e woman "for
reasons o
er
an ma ernal
eal
or fe al
disease."
  
 

= "Medical abor ions" are nonsurgical abor ions

a use p
armaceu ical drugs.
=
ombined regimens include me
o rexa e or
mifepris one, followed by a pros aglandin ei
er
misopros ol or gemepros : misopros ol is used in

e ..; gemepros is used in
e  and
weden.)
= 
en used wi
in 49 days ges a ion,
approxima ely 92% of women undergoing
medical abor ion wi
a combined regimen
comple ed i wi
ou surgical in erven ion.
= Misopros ol can be used alone, bu
as a lower
efficacy ra e
an combined regimens.
= n cases of failure of medical abor ion, vacuum
or manual aspira ion is used o comple e
e
abor ion surgically.


Y  
= n
e firs 12 weeks, suc ionaspira ion or vacuum abor ion is

e mos common me
od.
= R
   
 

MVA) abor ion consis s of
removing
e fe us or embryo, placen a and membranes by
suc ion using a manual syringe, w
ile 
 

 

EVA) abor ion uses an elec ric pump.
= MVA, also known as "minisuc ion" and "mens rual
ex rac ion", can be used in very early pregnancy, and does no
require cervical dila ion.
= urgical ec
niques are some imes referred o as 'uc ion or
surgical) Termina ion f regnancy' T). From
e 15

week un il approxima ely
e 26
, dila ion and evacua ion
D&E) is used. D&E consis s of opening
e cervix of
e
u erus and emp ying i using surgical ins rumen s and
suc ion.
= 2
 


  D&
),
e second mos
common me
od of abor ion, is a s andard
gynecological procedure performed for a varie y of
reasons, including examina ion of
e u erine lining
for possible malignancy, inves iga ion of abnormal
bleeding, and abor ion.   refers o cleaning

e walls of
e u erus wi
a cure e.

= 
er ec
niques mus be used o induce abor ion in

e second rimes er. rema ure delivery can be
induced wi
pros aglandin;
is can be coupled
wi
injec ing
e amnio ic fluid wi

yper onic
solu ions con aining saline or urea.
= Af er
e 16
week of ges a ion, abor ions can be
induced by in ac dila ion and ex rac ion  DX) also
called in rau erine cranial decompression), w
ic

requires surgical decompression of
e fe us's
ead
before evacua ion.
= DX is some imes called "par ialbir
abor ion,"
w
ic

as been federally banned in
e ni ed
 a es.
= A
ys ero omy abor ion is a procedure similar o a
caesarean sec ion and is performed under general
anes
esia. requires a smaller incision
an a
caesarean sec ion and is used during la er s ages of
pregnancy.
   



= Abor ion, w
en legally performed in developed

coun ries, is among
e safes procedures in
medicine. n suc
se ings, risk of ma ernal dea
is
be ween 0.2±1.2 per 100,000 procedures.
= nsafe abor ions defined by
e orld Heal

rganiza ion as
ose performed by unskilled
individuals, wi

azardous equipmen , or in
unsani ary facili ies) carry a
ig
risk of ma ernal
dea
and o
er complica ions. For unsafe
procedures,
e mor ali y ra e
as been es ima ed a
367 per 100,000.
 
 

= omen seeking o ermina e
eir pregnancies
some imes resor o unsafe me
ods, par icularly w
ere
and w
en access o legal abor ion is res ric ed.
= T
e orld Heal
rganiza ion H) defines an
unsafe abor ion as being "a procedure ... carried ou by
persons lacking
e necessary skills or in an environmen

a does no conform o minimal medical s andards, or
bo
.³
= nsafe abor ions are some imes known colloquially as
"backalley" abor ions. T
ey may be performed by
e
woman
erself, ano
er person wi
ou medical raining,
or a professional
eal
provider opera ing in sub
s andard condi ions.
= nsafe abor ion remains a public
eal
concern
due o
e
ig
er incidence and severi y of i s
associa ed complica ions, suc
as incomple e
abor ion, sepsis,
emorr
age, and damage o
in ernal organs.
= is es ima ed
a 20 million unsafe abor ions
occur around
e world annually and
a
70,000 of
ese resul in
e woman's dea
.
 

  
= Heal
educa ion
= access o family planning,
= improvemen s in
eal
care during and af er
abor ion
ave been proposed o address
is
p
enomenon.
 
Y 
Y 
= V , "



 °

") is a sexual dysfunc ion
c
arac erized by
e inabili y o develop or main ain
an erec ion of
e penis sufficien for sa isfac ory
sexual performance.
= An erec ion occurs as a
ydraulic effec due o blood
en ering and being re ained in spongelike bodies
wi
in
e penis. T
e process is mos of en ini ia ed
as a resul of sexual arousal, w
en signals are
ransmi ed from
e brain o nerves in
e penis.
= Erec ile dysfunc ion is indica ed w
en an erec ion is
difficul o produce.
= T
e mos impor an organic causes are
cardiovascular disease and diabe es, neurological
problems for example, rauma from pros a ec omy
surgery),
ormonal insufficiencies 
ypogonadism)
and drug side effec s.
= syc
ological impo ence is w
ere erec ion or
pene ra ion fails due o
oug
s or feelings
psyc
ological reasons) ra
er
an p
ysical
impossibili y.
= Erec ion, ied closely as i is abou ideas of p
ysical
well being, can
ave severe psyc
ological
consequences.
 YY  

= T
ere are several ways
a erec ile dysfunc ion
is analyzed:
= b aining full erec ions a some imes, suc
as
w
en asleep w
en
e mind and psyc
ological
issues, if any, are less presen ), ends o sugges

e p
ysical s ruc ures are func ionally working.
= 
er fac ors leading o erec ile dysfunc ion are
diabe es melli us causing neuropa
y).
 Y 
 Y 

= Drugs an idepressan s R s) and nico ine are

mos common.
= Neurogenic Disorders spinal cord and brain
injuries, nerve disorders suc
as arkinson's
disease, Alz
eimer's disease, mul iple sclerosis, and
s roke.
= syc
ological causes: performance anxie y, s ress,
men al disorders clinical depression,
sc
izop
renia, subs ance abuse, panic disorder,
generalized anxie y disorder, personali y disorders
or rai s.), psyc
ological problems, nega ive feelings.
= urgery radia ion
erapy, surgery of
e colon,
pros a e, bladder, or rec um may damage
e nerves
and blood vessels involved in erec ion. ros a e and
bladder cancer surgery of en require removing
issue and nerves surrounding a umor, w
ic

increases
e risk for impo ence.
= Ageing. is four imes
ig
er in men in
eir 60s

an in men in
eir 40s.
= idney failure
= ifes yle: moking is a key cause of erec ile
dysfunc ion. moking causes impo ence because i
promo es ar erial narrowing
  


= 
ysical exam and lab es

= Noc urnal Tumescence Moni oring appraise
e
abili y o a ain or main ain an erec ion by
measuring episodes of erec ion
a occur
normally during sleep

 
= Medica ionsAlpros adil
as become available in
some coun ries as a opical cream under
e
brand name Befar),and preliminary s udies
ave
s
own a clinical efficacy of up o 83%.
= V AGRA and HRMNE es os erone
= RTAGAND N NJE
T N
AAVER NE H
 ava ine); 
en olamine
mesy a e Regi ine); ros aglandin E1can
ac
ieve erec ion for approxima ely 1
our
= Ô

= enile pros
esis
= f en, as a las resor if o
er rea men s
ave failed,
e
mos common procedure is pros
e ic implan s w
ic

involves
e inser ion of ar ificial rods in o
e penis.
=


= Vacuum T
erapy
= T
e device
elps draw blood in o
e penis by applying
nega ive pressure. T
is ype of device is some imes
referred o as penis pump and may be used jus prior o
sexual in ercourse.
= FDA approved vacuum
erapy devices are available
wi
a doc or's prescrp ion

 
 Y 
= rema ure ejacula ion is w
en a man ejacula es
"comes") oo quickly during in ercourse.
= is very common in young males, bu can affec
males of any age.
 Y 
 Y 

= rema ure ejacula ion is almos always caused

by psyc
ological concerns ie. anxie y) ra
er

an a p
ysical problem.
= "erformance anxie y" mos of en occurs wi
a
new sexual par ner. However, i is perfec ly
na ural o be a bi nervous
e firs ime.
= 
ysical causes of prema ure ejacula ion include
diabe es, a ig
foreskin, and disorders of
e
nervous sys em.

 
= Be as relaxed as possible prior o lovemaking.
= T
e dis rac ion ec
nique:
= 
en you feel yourself reac
ing climax,
ink of some
ing non
sexual like naming
e players of your foo ball eam) 
is will
elp
ake your mind off sex & reduce
e c
ance of you climaxing oo
soon.
= T
e s opands ar ec
nique:
= 
en
e man recognises
a
e is abou o ejacula e, s op all
sexual s imula ion for ~30 seconds and
en resume lovemaking.
T
is can be repea ed as of en as required un il you are ready o
ejacula e.
= T
e squeeze ec
nique:
= queezing jus below
e ip of
e penis for 1020 seconds also

elps delay ejacula ion. T
is ec
nique can be repea ed as of en as
required un il you and your par ner are ready for you o ejacula e.
   
= Ë
°° 


= rema ure ejacula ion of en se les wi
ime as
your confidence grows wi
your par ner.
= Heal
care provider will be able o c
eck
a

ere is no p
ysical cause for prema ure
ejacula ion and can also
elp wi

counselling/advice if required.
  

Y



= formerly known as NH B TED MAE RGAM
= Male canno
ave an orgasm even
oug

e is

ig
ly aroused and
as a grea deal of sexual
s imula ion
= everi y of
e problem range from 

A NA
problem ejacula ing o a
is ory of necer
aving
experienced orgasm
= ncapable of orgasm during in ercourse BT maybe
able o ac
ieve orgasm
and or mou
s imula ion
= ncidence 12% of
e cases among people
seeking sex
erapy. Affec ing 410% of
e
general popula ionless common
=
auses syc
ologicalmos common
= 
ysicalDM



 Y 
= DRY RGAM
= occurs w
en semen, w
ic
would normally be
ejacula ed via
e ure
ra, is redirec ed o
e
urinary bladder. Normally,
e sp
inc er of
e
bladder con rac s before ejacula ion forcing
e
semen o exi via
e ure
ra,
e pa
of leas
pressure. 
en
e bladder sp
inc er does no
func ion properly, re rograde ejacula ion may
occur.
 Y 
 Y 

= A malfunc ioning bladder sp
inc er, leading o

re rograde ejacula ion, may be a resul of
e
au onomic nervous sys em or
e opera ion of
e
pros a e.
= is a common complica ion of TR, a procedure
in w
ic
pros a e issue is removed, slice by slice,

roug
a resec oscope passed along
e ure
ra.
= can also be caused by a re roperi oneal lymp

node dissec ion for es icular cancer if nerve
pa
ways o
e bladder sp
inc er are damaged wi


e resul ing re rograde ejacula ion being ei
er
emporary or permanen .
= Re rograde ejacula ion is a common side effec of
medica ions, suc
as amsulosin,
a are used o
relax
e muscles of
e urinary rac , rea ing
condi ions suc
as benign pros a ic
yperplasia.
ejacula ion is increased.
= T
e medica ions
a mos ly cause i are
an idepressan and an ipsyc
o ic medica ion;
pa ien s experiencing
is p
enomenon end o qui

e medica ions.
= Re rograde ejacula ion can also be a complica ion of
diabe es, especially in cases of diabe ics wi
long
erm poor blood sugar con rol. T
is is due o
neuropa
y of
e bladder sp
inc er.
  


= Diagnosis is usually by way of a urinalysis

performed on a urine specimen
a is ob ained
s
or ly af er ejacula ion.
= n cases of re rograde ejacula ion,
e specimen
will con ain an abnormal level of sperm.
= 
°
= A p
ysical exam of
e geni als is applied o
ensure
a
ere are no ana omical problems.
T
e urine will be examined for
e presence of
semen. f
ere are no sperm in
e urine, i may
be due o damage o
e pros a e as a resul of
surgery or prior radia ion
erapy.
   
= R
° 
° °
°
° 


° 
 


= Tricyclic an idepressan s like mipramine.
= An i
is amines like

lorp
enamine.
= Deconges an s like Ep
edrine and 
enylep
rine.
= T
ese medica ions ig
en
e bladder neck muscles and
preven semen from going backwards in o
e bladder.
= However,
e medica ions do
ave many side effec s and

ey
ave o be aken a leas 1±2
ours prior o sexual
in ercourse. n many cases,
e medica ions fail o work
a
e rig
ime because mos men are no able o
predic w
en
ey will
ave an orgasm.
 
 Y  
= Male dyspareunia or recurren painful sex
= Resul s from muscle spasm problem
a can
occur ei
er during ejacula ion or immedia ely
af er
=
aused by involun ary con rac ion of
e
ejacula ory muscula ure and some o
er
associa ed muscles
= sually subsides wi
in a few minu es bu can
las longer
  


= some imes  
 a condi ion w
ic
affec s

a woman's abili y o engage in any form of
vaginal pene ra ion, including sexual
in ercourse, inser ion of ampons, and
e
pene ra ion involved in gynecological
examina ions.
= T
is is
e resul of a condi ioned reflex of
e
pubococcygeus muscle, w
ic
is some imes
referred o as
e "
muscle".
= T
e reflex causes
e muscles in
e vagina o
ense suddenly, w
ic
makes any kind of vaginal
pene ra ion²including sexual in ercourse²
painful or impossible.
= A vaginismic woman does no consciously
con rol
e spasm.
= T
e severi y of vaginismus and
e pain during
pene ra ion, including sexual pene ra ion, varies
from woman o woman.


 


= occurs w
en a woman
as never been able o

ave pene ra ive sex or experience any kind of
vaginal pene ra ion wi
ou pain.
= commonly discovered in eenagers and women
in
eir early wen ies, as
is is w
en many
young women in
e es ern world will ini ially
a emp o use ampons,
ave some form of
pene ra ive sex, or undergo a ap smear.
= omen w
o
ave vaginismus may no be aware
of
eir condi ion un il
ey a emp vaginal
pene ra ion. may be confusing for a woman o
discover s
e
as vaginismus. 
e may believe

a vaginal pene ra ion s
ould na urally be
easy, or s
e may be unaware of
e reasons for

er condi ion.
 Y 
 Y 

= urinary rac infec ions or vaginal yeas

infec ions.
= sexual abuse, rape, or a emp ed sexual abuse
= knowledge of or wi nessing) sexual or p
ysical
abuse of o
ers, wi
ou being personally abused
= domes ic violence or conflic in
e early
ome
environmen
=
aving been aug

a sex is immoral, vulgar,
or demoralizing
= fear of pain associa ed wi
pene ra ion,
par icularly
e popular misconcep ion of
'breaking'
e
ymen upon
e firs a emp a
pene ra ion, or
e idea
a vaginal pene ra ion
will inevi ably
ur
e firs ime i occurs
= being sexualized or old abou sex in violen or
inappropria ely grap
ic erms before an age a
w
ic
one is comfor able wi
suc
informa ion
= any p
ysically invasive rauma
= generalized anxie y
= ccasionally, primary vaginismus is idiopa
ic
= Vaginismus
as been classified by amon
according o
e severi y of
e condi ion. He
describes four degrees of vaginismus:
= n firs degree vaginismus,
e pa ien
as spasm
of
e pelvic floor w
ic
can be relieved wi

reassurance.
= n second degree,
e spasm is presen bu
main ained
roug
ou
e pelvis even wi

reassurance.
= n
ird degree,
e pa ien eleva es
e bu ocks
o avoid being examined.
= n four
degree vaginismus also known as
grade 4 vaginismus),
e mos severe form of
vaginismus,
e pa ien eleva es
e bu ocks,
re rea s and ig
ly closes
e
ig
s o avoid
examina ion.
= T
e amon classifica ion con inues o be used
o
e presen and allows for a common
language among researc
ers and
erapis s.
= T
oug
spasm of
e pubococcygeus muscle is
commonly
oug
o be
e primary muscle
involved in vaginismus, acik iden ified 2
addi ional involved spas ic muscles in rea ed
pa ien s under seda ion. T
ese include
e en ry
muscle bulbocavernosum) and
e mid vaginal
muscle puborec alis). T
is accoun s for
e
common complain
a pa ien s of en say w
en
rying o
ave in ercourse " 's like
i ing a
brick wall".

Y
 


= econdary vaginismus occurs w
en a woman

w
o
as previously been able o ac
ieve
pene ra ion develops vaginismus.
= T
is may be due o p
ysical causes suc
as a
yeas infec ion or rauma during c
ildbir
, or i
may be due o psyc
ological causes. T
e
rea men for secondary vaginismus is
e same
as for primary vaginismus, al
oug
, in
ese
cases, previous experience wi
successful
pene ra ion can assis in a more rapid resolu ion
of
e condi ion.

 
= O

°
°

°
= According o ard and gden's quali a ive
s udy on
e experience of vaginismus for
women 1994),
e
ree mos common
con ribu ing fac ors o vaginismus are fear of
painful sex;
e belief
a sex is wrong or
s
ameful of en
e case wi
pa ien s w
o
ad a
s ric religious upbringing); and rauma ic early
c
ild
ood experiences no necessarily sexual in
na ure).
= Vaginismus pa ien s are wice as likely o
ave a

is ory of c
ild
ood sexual in erference and
eld
less posi ive a i udes abou
eir sexuali y
= i is impor an o address
e psyc
ological
aspec s of
e problem as well as
e ac ual
muscle spasm.
= A woman may c
oose o address
e issue on
er
own erms, or s
e may avail
e
elp of a

erapis .
= ome women, especially
ose wi
secondary
vaginismus, may rely on a p
ysical ra
er
an
psyc
ological rea men and also be successful.
T
ere are emo ional difficul ies associa ed wi

vaginismus, w
ic
can include low selfes eem,
fears, and depression.
 
Y 
 
= 
ysical rea men of
e in ernal spasms may
include sensa e focus exercises, exploring
e
vagina
roug
ouc
, and desensi iza ion wi

vaginal dila ors.
= Dila ing involves inser ing objec s, usually
p
allic in s
ape, in o
e vagina. n rea ing
e
spasms
roug
dila ion,
e objec s used
gradually increase in size as
e woman
progresses.
= Medical dila ors may be ob ained online,
oug


ey may be expensive.
= Bo ox is a rela ively new rea men for
vaginismus, firs described in 1997
= G
azizade
and Nikzad repor ed on
e use of
bo ulinum oxin in
e rea men of refrac ory
vaginismus in 24 pa ien s.
= Medica ion: Dyspor a ype of Bo ox) 150400
m   psen  d, ni ed ingdom)
= A con rolled s udy using Bo ox for one group of
pa ien s was compared o saline in ano
er. 8
women rea ed wi

e Bo ox were able o
ac
ieve sa isfac ory in ercourse w
ereas 5
women w
o were injec ed wi
saline con rols
s
owed no response.
= None of
e 8 women w
o
ad Bo ox required
any fur
er rea men . T
e procedure is simple,
easy, cos effec ive, no imeconsuming and can
be ac
ieved on an ou pa ien basis. No
complica ions were repor ed.
= acik repor ed
e use of in ravaginal Bo ox, and
progressive dila ion under seda ion in 20
pa ien s. 12 of
ese pa ien s were a amon
level 4 primary vaginismus,
e mos severe
form of vaginismus.
= He repor s a 90%+ success ra e of pa ien s
ac
ieving in ercourse in 2 weeks o 3 mon
s. n

is series
ere were no complica ions and no
recurrences.
 

 
= Many people do no realize
a i is common,
even in pa ien s w
o do no suffer from
vaginismus, for a woman o experience pain or
discomfor if s
e a emp s sexual pene ra ion
wi
ou firs being sufficien ly aroused.
= Mos women acknowledge sexual arousal as vi al
o ac
ieving comfor able pene ra ion, so self
explora ion of
e vaginal area
roug

mas urba ion can be beneficial in addressing
vaginismus.
= ne of
e problems w
ic
may accompany
vaginismus is
a a woman may be ex remely

esi an o engage in pene ra ive sexual ac ivi y
wi
o
ers, due o a fear of pain associa ed wi

any kind of vaginal pene ra ion.
= olo mas urba ion, wi
or wi
ou pene ra ion,
can allevia e
is fear, as well as
e
psyc
ological pressure o "perform" sexually or
become aroused quickly wi
a par ner.
    
Y

= A wide range of emo ions may surface during

mas urba ion and o
er forms of geni al
explora ion.
= ome women
ave nega ive associa ions wi


eir geni als, including fears
a
eir geni als
are dir y, smelly, oddly s
aped, or ugly. T
ese
associa ions can lead o nega ive emo ions
arising during any kind of sexual expression,
including mas urba ion, and
ese emo ions can
ake ime o process.
= Especially in
e case of a vaginismic woman,
feelings of ex reme s
ame, inadequacy or fear of
being "defec ive" can be deeply roubling.
= f mul iple a emp s o pene ra e are made
before rea ing vaginismus, i may lead o fear of
sexual in ercourse, and worsen
e amoun of
pain experienced wi
eac
subsequen a emp .
= Relaxa ion, pa ience and selfaccep ance are
vi al o a pleasurable experience.

  

 
= Dyspareunia is painful sexual in ercourse, due o
medical or psyc
ological causes.
= T
e erm is used almos exclusively in women,
al
oug

e problem may occur in men. T
e
causes are of en reversible, even w
en long
s anding, bu selfperpe ua ing pain is a fac or
af er
e original cause
as been removed.
= Dyspareunia is considered o be primarily a
p
ysical, ra
er
an an emo ional, problem
un il proven o
erwise.
= n mos ins ances of dyspareunia,
ere is an
original p
ysical cause. Ex reme forms, in w
ic


e woman's pelvic floor muscula ure con rac s
involun arily, is ermed vaginismus.
= According o DM V American syc
ia ric
Associa ion 1994),
e diagnosis of dyspareunia
is made w
en
e pa ien complains of recurren
or persis en geni al pain before, during, or af er
sexual in ercourse
a is no caused exclusively
by lack of lubrica ion or by vaginismus.
=
linically, i is of en difficul o separa e
dyspareunia from vaginismus, since vaginismus
may occur secondary o a
is ory of dyspareunia
and even mild vaginismus is of en accompanied
by dyspareunia.
= is impor an o es ablis
w
e
er
e
dyspareunia is acquired or lifelong and w
e
er
i is generalized comple e) or si ua ional.
= Fur
er inquiry s
ould de ermine w
e
er
e
pain is superficial or deep  w
e
er i occurs
primarily a
e vaginal ou le or vaginal barrel
or upon deep
rus ing agains
e cervix. Even
w
en
e pain can be reproduced during a
p
ysical examina ion,
e possible role of
psyc
ological fac ors in ei
er causing or
main aining
e pain mus be acknowledged and
deal wi
in rea men .
 YY  

= 
en pain occurs,
e woman may be dis rac ed
from feeling pleasure and exci emen . Bo

vaginal lubrica ion and vaginal dila ion
decrease.
= 
en
e vagina is dry and undila ed, penile

rus ing is painful. Even af er
e original
source of pain a
ealing episio omy, for
example)
as disappeared, a woman may feel
pain simply because s
e expec s pain.
= dyspareunia can be classified by
e ime elapsed
since
e woman firs fel i :
= During
e firs 2 weeks or so, dyspareunia
caused by penile inser ion or movemen of
e
penis in
e vagina or by deep pene ra ion is
of en due o disease or injury deep wi
in
e
pelvis.
= Af er
e firs 2 weeks or so,
e original cause of
dyspareunia may s ill exis wi

e woman s ill
experiencing
e resul an pain. r i may
ave
disappeared, bu
e woman
as an icipa ory
pain associa ed wi
a dry, ig
vagina.
 Y 
 Y 

= infec ions candidiasis, c
lamydia,

ric
omoniasis, urinary rac infec ions),
umours, xerosis dryness, especially af er
e
menopause) and EA.
= Dyspareunia may resul from female geni al
mu ila ion, w
en
e in roi us
as become oo
small for normal pene ra ion of en worsened by
scarring).
O
 





= a careful p
ysical examina ion and medical

is ory are always indica ed wi
complain s.
= n women, common p
ysical causes for coi al
discomfor include infec ions of
e vagina,
lower urinary rac , cervix, or fallopian ubes
e.g., Tric
omonas, coliform bac eria, myco ic
organisms); endome riosis; surgical scar issue
following episio omy); and ovarian cys s and
umours Bancrof 1989).
= n addi ion o infec ions and c
emical causes of
dyspareunia suc
as monilial organisms and

erpes, ana omic condi ions, suc
as
ymenal
remnan s, can con ribu e o coi al discomfor
arrell and arrell 1989).
= Es rogen deficiency is a par icularly common
cause of sexual pain complain s among
pos menopausal women, al
oug
vaginal
dryness is of en repor ed by lac a ing women as
well Bac
mann e al 1984).
= omen undergoing radia ion
erapy for pelvic
malignancy of en experience severe dyspareunia
due o
e a rop
y of
e vaginal walls and
eir
suscep ibili y o rauma.
 O
 
O 
 



= ain is some imes experienced in
e es icular
or glans area of
e penis immedia ely af er
ejacula ion.
= nfec ions of
e pros a e, bladder, or seminal
vesicles can lead o in ense burning or i c
ing
sensa ions following ejacula ion.
= Gonorr
oeal infec ions are some imes
associa ed wi
burning or s
arp penile pains
during ejacula ion.
= re
ri is or pros a i is can make geni al
s imula ion painful or uncomfor able. Ana omic
deformi ies of
e penis, suc
as exis in
eyronie's disease, may also resul in pain
during coi us.
= ne cause of painful in ercourse is due o
e
painful re rac ion of a oo ig
foreskin,
occurring ei
er during
e firs a emp a
in ercourse or subsequen o ig
ening or
scarring following inflamma ion or local
infec ion Bancrof 1989).
= During vigorous in ercourse or mas urba ion,
small ears may occur in
e frenum of
e
foreskin and can be very painful.
= A rare form of male dyspareunia 
pos ejacula ory pain syndrome  is c
arac erized
by persis en and recurring pain in
e geni al
organs during ejacula ion or immedia ely

ereaf er.
= T
e painful sensa ions are experienced as s
arp,
s abbing, and/or burning.
= A pelvic floor disorder can also be
e cause of
pain during and af er sex. pasming, inflammed,
over oned or s
or ened pelvic muscles can resul
in
e compression or some imes
e
en rapmen of
e pudendal nerve.
= Guil abou sexual pleasure or abou
e
parap
iliac na ure of
e ero ic fan asies can
lead o pain wi
orgasm.

 
= Trea men for dyspareunia involves rea ing any
TDs presen , rea ing condi ions like pelvic
inflamma ory disease, and using lubrica ion
during sex.
= ex
erapy may also be useful in women wi

psyc
ological causes for
is condi ion.
   Y 
 








=

arac erized by a loss of a rac ion o formerly
exci ing s imuli and a lack of pleasure even in
s imula ion of
e sex organs
 Y 
 Y 

= Hormonal replacemen
erapy

= se of oral con racep ives
= Ea ing disorders
=  gain or loss
= ubs ance abuse
=

ronic illness
= syc
ological abuse, mari al conflic , family
violence, depression, environmenm al s ressors
anxie y fear

  





=

arac erized by fear or disgus abou sex and
avoidance of sexual ac ivi y and is genera ed by
anxie ies and p
obias abou sexual con ac
 Y 
 Y 

= n
ibi ing or puni ive upbringing

= Rigidly religious background
= Heal
concerns
= His ory of p
ysical and or sexual abuse
  
 

= HRT or oral con racep ive userefer o

gynecologis
= ugges reading and viewing ero ic ma erials;
c
ange ime and se ing of sexual ac ivi ies
= Drug and alco
ol abuse or c
ronic illnessmeds,
mg of
e underlying fac or is required before
o
er in erven ion
= nform rela ions
ip be ween
e underlying
causes and
e reul ing dysfunc ion
= T
erapeu ic communica ion
= Encourage oo pursue in ensive rea men
= THER THERA E
= Mari al
erapy
e rela ions
ip be ween

usbamd and wife is rea ed
= syc
osexual
erapy
erapis will
elp
explore or unders and
e reasons be
ind
e
problem and look for ways of resolving
em
= ndividual
erapy rea ing
e person¶s
individual adjus men wi

e goal of rying o
resolve conflic s
Ł A. be
avior
erapy
elps weaken
e
connec ions be ween roublesome si ua ion and

abi ual reac ions o
em
Ł B. cogni ive
erapy eac
es
ow cer ain
inking
pa erns can call
e symp oms= ³
GN T VE
RE
NTR
T NG´
 
 
Y 
=
ommunica e wi
your par ner
= Don¶ be a spec a or= do your par
= Don¶ se up goals per sexual performance
= Be c
oosy abou
e si ua ions in w
ic
you
ave
sex
= Failures will occur

 

 


= A disease acquired
roug
sexual con ac wi

an infec ed person
= R  FA
TR for TDs increases for
individuals w
o engage in
e ff:
ig
risk
be
aviors
= Having sexual rela ions wi
infec ed individuals
wi
mul iple par ners or wi
pros i u e
= Engaging oral sex or anal sex
= sing V injec ion drugs
Y Y




!"#$$% "
=

ancroid sexual
=

lamydiasexual
=
MVsexual, less in ima e con ac
= Gonorr
ea sexual, perina al
= Hep B virusHBV) sexual, percu aneaous,
perina al
= HE
virus percu aneaous, probably sexual,
probably perina al
= Herpes simplex sexual
= H V/A D sexual, percu aneous, perina al
= HV sexual
= yp
ilissexual, peina al

 

= yp
ilis is a sexually ransmi ed disease TD)

caused by a bac eria spiroc
e e) TRENEMA
A DM.
= progresses in s ages and, wi
ou rea men ,
can lead o dea
.
= yp
ilis can be spread during vaginal, anal, or
oral sex
roug
con ac wi
an open sore or
con ac wi
a skin ras
.
= T
e bac eria can en er
e body
roug

e
penis, anus, vagina, mou
, or
roug
broken
skin. An infec ed pregnan woman can also pass

e disease o
er unborn c
ild. yp
ilis is no
spread by con ac wi
oile sea s, doorknobs,
swimming pools,
o ubs, ba
ubs, s
ared
clo
ing, or ea ing u ensils.
 YY  

= Eac
s age of syp
ilis
as differen symp oms.
yp
ilis can be spread during
e firs wo s ages
of
e disease.
= O
Ô°

A single, painless sore, called a c
ancre, appears
in
e firs , or primary s age, abou 10 days o 90
days af er infec ion.
= T
e sore can appear on
e vulva, vagina, cervix,
ongue, lips, or o
er par s of
e body, including
inside
e body.
= 21 days af er infec ion is
e mos common ime
frame in w
ic

e sore appears. T
e sore
eals
wi
or wi
ou rea men .
= n
is s age, syp
ilis can be passed o o
ers

roug
con ac wi
an open sore during
vaginal, anal, or oral sex. f
e infec ion is no
rea ed, i moves o
e nex , or secondary, s age.
= Ô
 Ô°

n
e secondary s age, w
ic
s ar s
ree o six
weeks af er
e sore appears, some or all of
ese
symp oms can appear:
= skin ras
wi
roug
, red or reddis
brown
spo s bo
on
e palms of
e
ands and
bo oms of
e fee . T
e ras
usually does no
i c
. Ras
es wi
a differen appearance may
occur on o
er par s of
e body.
= sores on
e
roa , mou
, or cervix
= fever
= pa c
y
air loss on
e
ead and o
er par s of

e body
=
eadac
es and muscle ac
es
= weig
loss; iredness
= During vaginal, anal, or oral sex, con ac wi

open sores or con ac wi

e ras
can spread

e infec ion o o
ers.
= T
e symp oms of secondary syp
ilis will resolve
wi
or wi
ou rea men . Bu wi
ou
rea men ,
e infec ion will progress o
e
la en and la e s ages of disease.
= à°
°Ô°
or
idden s age.
= T
is s age can s ar from wo years o over
ir y
years af er ini ial infec ion. Af er symp oms from

e secondary s age disappear, a relapse of
e
second s age of syp
ilis can
appen, w
en
ose
symp oms come back.
= n
e la e s age of syp
ilis, some people suffer
damage o
e brain, nerves, eyes,
ear , blood
vessels, liver, bones, and join s.
=
omplica ions may include small bumps or
umours on organs, blindness, insani y, or
paralysis.
= T
is s age can las for years. ome people may
die from
e disease. You will only reac

is
s age if you
ave no received rea men earlier.
  
Y
Y

= Recognizing i s signs and symp oms and aking

e correc es s.
= ooking a
e fluid from a syp
ilis sore or
swollen lymp
node under a microscope. T
is
can only be done during primary and secondary
syp
ilis w
en a pa ien
as sores.
= Tes ing
e pa ien 's blood.
 Y






= yp
ilis can be cured. enicillin is
e preferred
drug o rea syp
ilis a all s ages. T
e dose and
leng
of rea men depends on
e s age of
syp
ilis and symp oms of
e disease.
= f a person can' ake penicillin, ano
er
medicine may be available. Bu in la e syp
ilis,
damage already done o body organs canno be
reversed. You can ge syp
ilis again af er being
cured if you are exposed o i . Taking an ibio ics
does no pro ec you from ge ing syp
ilis again.
 



 
= Avoid
aving   sexual ac ivi y w
ile you are
being rea ed for syp
ilis. Don'
ave sexual
con ac un il
e syp
ilis sores are comple ely

ealed.
= Be sure o ell your sexual par ners, so
ey can
be es ed and rea ed if necessary.
= Af er you
ave comple ed rea men for syp
ilis,
ge re es ed af er six mon
s and 12 mon
s.
ome doc ors recommend more frequen follow
up es s.
 Y
 
  

 




= regnan women can pass syp
ilis o
eir
babies during pregnancy and c
ildbir
.
= can cause miscarriage, s illbir
, or dea

soon af er bir
.
= An infec ed baby may be born wi
ou signs of
disease. However, if no rea ed rig
away,
e
baby may
ave serious problems wi
in a few
weeks.
= Babies born wi
syp
ilis may develop skin
sores, ras
es, fever, jaundice , anemia or a
swollen liver and spleen. n rea ed babies may
become developmen ally delayed,
ave seizures,
or die.
= regnan women wi
syp
ilis are rea ed rig

away wi
penicillin. DXY
Y NE, if allergic
= Trea men during
e 2nd
alf of pregnancy may
no elimina e
e risk for prema ure labor and
fe al dis ress
 


= a sexually ransmi ed disease TD). T
is
means
a you ge i by
aving oral, anal, or
vaginal sex wi
someone w
o
as gonorr
oea.
's caused by a ype of bac eria  NE ER A
GNRRHEA)
a can grow in warm, mois
areas of
e reproduc ive rac , like
e cervix,
u erus, and fallopian ubes in women as well as

e ure
ra in men and women. Gonorr
oea can
also grow in
e mou
,
roa , eyes, and anus.
 





= T
is TD is spread
roug
con ac wi
an
infec ed vagina, penis, anus, or mou
.
= is spread
roug
semen or vaginal fluids
during unpro ec ed sexual con ac wi
a par ner
w
o
as i .
= Touc
ing infec ed sex organs, like
e vagina or
penis, and
en ouc
ing your eyes can cause an
eye infec ion. canno be passed by s
aking

ands or si ing on a oile sea .
= Gonorr
oea can also be passed from a pregnan
woman o
er baby during
e bir
process

roug
a vaginal delivery.
= n babies, gonorr
oea infec ion may cause
blindness, join infec ion, or a life
rea ening
blood infec ion.


 Y 

= Any sexually ac ive person can be infec ed wi

gonorr
oea.
= n
e ni ed  a es,
e
ig
es repor ed ra es
of infec ion are among sexually ac ive eenagers,
young adul s, and African Americans.
 YY  

= Mos women w
o
ave gonorr
oea
ave

  . 
en a woman does
ave
symp oms,
ey mos of en appear wi
in 10
days of ge ing
e TD.
= ain or burning w
en passing urine
= Vaginal disc
arge
a is yellow or some imes
bloody
= Bleeding be ween mens rual periods
= Heavy bleeding wi
periods
= ain during sex
= Any geni al symp oms suc
as disc
arge,
burning during urina ion, or pain during sex
s
ould be a signal o s op
aving sex and o see a
doc or rig
away.
= omen wi
gonorr
oea are a risk of
developing serious complica ions from
e
infec ion, w
e
er or no
ere are symp oms.
= Men and women wi
an anal infec ion mig


ave symp oms
a may include disc
arge,
soreness, bleeding, or i c
ing of
e anus, and
painful bowel movemen s.
= nfec ions in
e
roa may cause a sore
roa
bu usually cause no symp oms.
= i
an eye infec ion, symp oms may include
redness, i c
ing, or disc
arge from
e eye.
  
Y
Y


= Ô 


 A swab sample from
e par of

e body likely o be infec ed cervix, ure
ra,
penis, rec um, or
roa ) can be sen o a lab for
es ing.
= 
°
° Gonorr
oea in
e cervix or ure
ra
can be diagnosed wi
a urine sample sen o a
lab.
= Ë
°  T
is is done rig
in a clinic or
doc or's office. A sample from
e ure
ra or a
cervix is placed on a slide and s ained wi
dye.
allows
e doc or o see
e bac eria under a
microscope. T
is es works be er for men
an
for women.

 
= An ibio ics are used o cure gonorr
oea. Many
people w
o
ave gonorr
oea also
ave ano
er
TD called c
lamydia.
= Doc ors of en give a combina ion of an ibio ics
o rea bo
TDs.
efriaxone Rocep
in);

efixime uprax);
iprofloxacin
ipro);
floxacin  Floxin)
= Finis
all
e medicine
a you are prescribed
by your doc or, even if symp oms subsides.
= Talk wi
all of your sexual par ners. T
ey
s
ould ge es ed and rea ed for gonorr
oea,
even if
ey don'
ave any symp oms.
= Also avoid sexual con ac un il you and your
par ners)
ave been rea ed and cured.
= eople w
o
ave
ad gonorr
oea and received
rea men may ge infec ed again if
ey
ave
sexual con ac wi
a person w
o
as
gonorr
oea.
  


 





= ncreased risk of ge ing H V or spreading H V
= elvic inflamma ory disease  D).  D is an
infec ion in a woman's pelvic organs, like
e
u erus, fallopian ubes, and ovaries.
= omen wi
 D do no necessarily
ave
symp oms. 
en symp oms are presen ,
ey
can be severe and can include abdominal pain,
fever, backac
e, irregular periods, pain during
sex, and vaginal disc
arge.
= T
is infec ion can lead o infer ili y. can also
cause ec opic pregnancy. T
is can cause
miscarriage and possibly dea
of
e mo
er.
 D can also cause longlas ing, c
ronic pelvic
pain.
= idespread infec ion o o
er par s of
e body,
like
e blood, join s, or
ear
Y

 
 
  

 




= A pregnan woman wi
un rea ed gonorr
oea
may be a risk for miscarriage, pre erm delivery,
or
aving
er wa er break oo early.
= 
e may give
e infec ion o
er baby as
e
baby passes
roug

e bir
canal during
delivery.
= T
is can cause blindness, join infec ion, or a
life
rea ening blood infec ion in
e baby.
= Trea ing
e newborn's eyes wi
an an ibio ic
immedia ely af er delivery can preven serious
eye infec ions.
= Trea men of gonorr
oea as soon as i is found
in pregnan women will reduce
e risk of
ese

eal
problems.
= All sex par ners of pregnan women mus also be
rea ed. regnan women s
ould alk wi

eir
doc ors for es ing and rea men s
a are safe
for
em.
 Y
=

lamydia is
e mos frequen ly repor ed
sexually ransmi ed disease TD) caused by

  
   
) in
e .
= An es ima ed 2.8 million Americans ge
c
lamydia eac
year. omen are of en
reinfec ed, if
eir sex par ners are no rea ed.
= Reinfec ions place women a
ig
er risk for
serious reproduc ive
eal
complica ions,
including infer ili y.
 




= exually ac ive women and men can ge
c
lamydia
roug
sexual con ac wi
an
infec ed person.
=

lamydia can be passed during vaginal, anal, or
oral sex. Because
ere are of en symp oms,
people w
o are infec ed may unknowingly pass
c
lamydia o
eir sex par ners.
= An infec ed mo
er can also pass c
lamydia o

er baby during c
ildbir
. Babies born o
infec ed mo
ers can ge pneumonia or
infec ions in
eir eyes, also called conjunc ivi is.
= T
e more sex par ners a person
as,
e grea er

e risk of ge ing infec ed wi
c
lamydia.


lamydia is easily confused wi
gonorr
ea,
ano
er TD. BTH
ave similar symp oms and
can
ave similar complica ions if no rea ed, bu

e wo TDs
ave differen rea men s.
 YY  

=

lamydia is known as a "silen " disease because
75 percen of infec ed women and a leas
alf of
infec ed men
ave no symp oms.
= f symp oms do occur,
ey usually appear
wi
in 1 o 3 weeks of exposure. ymp oms, if
any, mig
include an abnormal vaginal
disc
arge or a burning sensa ion w
en
urina ing.
= T
e infec ion is of en no diagnosed or rea ed
un il
ere are complica ions. f you
ink you

ave c
lamydia or are concerned abou i , bo

you and your sex par ner s
ould see a doc or
rig
away.
= T
e infec ion firs a acks
e cervix and ure
ra.
Even if
e infec ion spreads from
e cervix o

e u erus and fallopian ubes, some women may
s ill
ave no signs or symp oms.
= f you do
ave symp oms, you mig

ave lower
abdominal pain, low back pain, nausea, fever,
pain during sex, and bleeding be ween
mens rual periods.
= Men wi
symp oms mig

ave a disc
arge
from
e penis and a burning sensa ion w
en
urina ing. Men mig
also
ave burning and
i c
ing around
e opening of
e penis or pain
and swelling in
e es icles, or bo
. T
e
bac eria also can infec
e
roa from oral
sexual con ac wi
an infec ed par ner.
  
Y
Y


= nly a doc or or nurse can diagnose c
lamydia.

T
ere are labora ory es s o diagnose
c
lamydia. ome es s involve ge ing a sample
from an infec ed si e cervix or penis) o be
es ed for
e bac eria.
= A urine es can also ell if you
ave
e bac eria.
A ap es smear es ) is no a es for
c
lamydia.
= T
e following people s
ould
ave a es for
c
lamydia:
= All sexually ac ive females 25 and under, once a
year.
= omen older
an 25 s
ould consider
aving a
es for c
lamydia if
ey:
= Have new or mul iple sex par ners
= Have sex wi
someone w
o
as o
er sex
par ners
= Do no use condoms during sexual ac ivi y
wi
in a rela ions
ip
a is no mu ually
monogamous
= f you
ave unusual vaginal disc
arge, burning
wi
urina ion, make sure o see your doc or.

 
= An ibio ics are used o rea and cure
c
lamydia. A single dose of 
 

or a
week of  

 are
e mos commonly
used rea men s.
= All sex par ners s
ould also be rea ed o avoid
reinfec ion.
= You s
ould no
ave sex un il you and your sex
par ners)
ave finis
ed rea men . T
ere are
safe an ibio ics o cure c
lamydia during
pregnancy.
  



 
  
=

lamydia is easily rea ed, bu i 's impor an for
you o seek es ing and ge rea men rig
away.
= Ge i rea ed rig
away. Visi a clinic, doc or, or
nurse.
= Researc
sugges s
a
aving an TD increases
your risk for ge ing infec ed wi
H V,
e virus

a causes A D.
= Follow your doc or's orders and finis
all
e
medicine
a you are given. Even if
e
symp oms go away, you s ill need o finis
all of

e medicine.
= Avoid
aving any sexual ac ivi y w
ile you are
being rea ed for c
lamydia.
= Tell your sexual par ners, so
ey can be rea ed
oo.
= Ge a followup es
ree o four mon
s af er
rea men o make sure
a
e infec ion
as
been cured.
= ee your doc or again if your symp oms do no
disappear wi
in one o wo weeks af er
finis
ing
e medicine.
= ee your doc or again wi
in 3 o 4 mon
s for
ano
er c
lamydia es , especially if your sex
par ner was no rea ed or if you
ave a new sex
par ner.

  


 



 
= can cause serious reproduc ive and o
er
eal

problems. ike
e disease i self,
e damage

a c
lamydia causes is of en "silen ."
= n women,
e c
lamydia bac eria of en infec

e cells of
e cervix. f no rea ed,
e
infec ion can spread in o
e u erus, fallopian
ubes, and ovaries and cause 



   
   D). T
is
appens in up
o 40 percen of women wi
un rea ed
c
lamydia..
=  D can cause:
= ÷ 
°
°
=  
°  °

  
=   

  ain
a is ongoing,
usually from scar issue.
= n rea ed c
lamydial infec ions can also cause
inflamma ion of
e bladder. omen w
o
ave
c
lamydia may also be more likely o ge H V,

e virus
a causes A D, from a person w
o is
infec ed wi
H V.
= n people
aving anal sex wi
a par ner w
o
as
c
lamydia,
e bac eria can cause proc i is,
w
ic
is an infec ion of
e lining of
e rec um.
T
e bac eria causing c
lamydia infec ions can
also be found in
e
roa s of people w
o
ave
oral sex.
= n rea ed c
lamydia in men ypically causes
infec ion of
e ure
ra,
e ube
a carries
urine from
e body.
= nfec ion some imes spreads o
e ube
a
carries sperm from
e es is. T
is may cause
pain, fever, and even infer ili y.
= n pregnan women, c
lamydia infec ions may
lead o prema ure delivery. Babies born o
infec ed mo
ers can ge infec ions in
eir eyes,
called conjunc ivi is or pinkeye, as well as
pneumonia.
= ymp oms of pneumonia are a coug

a
s eadily ge s worse and conges ion, usually
s
owing up wi
in
ree o six weeks of bir
.
 

  
= ° 

 prac ice abs inence, or no

aving vaginal, anal, or oral sex.
= 
° 

= 
 
 s
ould be used for any ype of
sex wi
every par ner. For vaginal sex, use a
la ex male condom or a female polyure
ane
condom. For anal sex, use a la ex male condom.
For oral sex, use a den al dam. A den al dam is a
rubbery ma erial
a can be placed over
e
anus or
e vagina before sexual con ac
 @ !"#$Y##%
= Vaginal
rus
is a vaginal yeas infec ion
a
causes irri a ion of
e vagina and
e area
around
e vagina, called
e vulva.
= is caused by an overgrow
of
e fungus or
yeas
andida. Yeas normally live in
e vagina
in small numbers, bu w
en
e bac eria in
e
vagina become ou of balance, oo many yeas
grow and cause an infec ion.
= Vaginal yeas infec ions are very common. Abou
75 percen of women
ave a yeas infec ion
during
eir lives. And almos
alf of women

ave wo or more yeas infec ions.
 YY  

= T
e mos common symp om of a yeas infec ion
is ex reme i c
iness in and around
e vagina.
= Burning, redness, and swelling of
e vagina and

e area around i
= ain w
en urina ing
= ain or discomfor during sex
= A
ick, w
i e vaginal disc
arge
a looks like
co age c
eese and does no
ave a bad smell
  
Y
Y

= MD will do a pelvic exam o look for swelling
and disc
arge.
= MD may also use a swab o ake a sample from

e vagina. A quick look under
e microscope or
a lab es will s
ow if yeas is causing
e
problem.
 
 




= Many
ings can c
ange
e acidi y of
e vagina
and boos your c
ances of a vaginal yeas
infec ion. T
ese include:
= s ress
= lack of sleep
= sickness
= poor die , or ex reme in ake of sugary foods
= pregnancy
=
aving your period
= aking bir
con rol pills
= aking an ibio ics
= aking s eroid medicines
= diseases suc
as poorlycon rolled diabe es and
H V infec ion
 Y

 



 
 &

'
= Yes, bu i is rare. omen usually do no ge
yeas infec ions from sex. ns ead, a weakened
immune sys em is
e mos common cause of
yeas infec ions.

 
= Yeas infec ions can be cured wi
an ifungal
medicines in
e form of creams, able s,
oin men s or supposi ories
a are inser ed in o

e vagina.
= T
ese medicines include bu oconazole,
clo rimazole, miconazole, nys a in, ioconazole
and erconazole. T
ese produc s can be boug

over
ecoun er a
e drug s ore or grocery
s ore. Your doc or can also prescribe you a single
dose of oral fluconazole.
= nfec ions
a do no respond o
ese
medicines are becoming more common. sing
an ifungal medicines w
en you don' really
ave
a yeas infec ion can boos your risk of ge ing a

ard o rea infec ion in
e fu ure.
 &
 



(

' 
 







= No unless
e s
ows signs of a yeas infec ion.
Rarely, men w
o
ave sex wi
women wi

yeas infec ions will ge an i c
y ras
on
eir
penis. f
is
appens,
e s
ould see
is doc or.
 












=
all your doc or. Abou five percen of women
develop four or more vaginal yeas infec ions in
one year.
= T
is is called recurren vulvovaginal candidiasis
RVV
). RVV
is more common in women wi

diabe es or weakened immune sys ems. Doc ors
normally rea
is problem wi
an ifungal
medicine for up o six mon
s.
 

  
= Don' use douc
es.
= Avoid scen ed
ygiene produc s like bubble ba
, sprays,
pads and ampons.
=

ange ampons and pads of en during your period.
= Don' wear ig
underwear or clo
es made of syn
e ic
fibers.
= ear co on underwear and pan y
ose wi
a co on
cro c
.
=

ange ou of we swimsui s and exercise clo
es as soon
as possible.
  


= Geni al
erpes is a sexually ransmi ed disease

caused by
e  
 
 HV) ype
1 and ype 2. Mos geni al
erpes is caused by
HV ype 2.
= Mos people
ave no or minimal symp oms from
HV1 or HV2 infec ion.
= 
en symp oms do occur,
ey usually appear
as one or more blis ers on or around
e geni als
or rec um.
= T
e blis ers break, leaving ulcers or ender sores

a may ake up o four weeks o
eal. Typically,
ano
er ou break can appear weeks or mon
s
la er.
= ne can pass geni al
erpes o someone else
even w
en you experience no symp oms.
 




= Herpes is a virus
a can be passed
roug

sexual con ac . You can ge geni al
erpes by

aving sex wi
someone w
o
as open sores
and w
en someone
as no sores.
= However,
erpes is mos con agious w
en a
person
as open sores. eople wi

erpes
s
ould no
ave sexual ac ivi y w
en sores or
o
er symp oms of
erpes are presen .
= HV1 can cause geni al
erpes, bu i more
commonly causes infec ions of
e mou
and
lips or ³fever blis ers.´
=
ondoms can lower
e c
ances of ge ing

erpes. Along wi
condoms, @   
, a
drug used o rea
erpes, can
elp lower
e
c
ances of passing
e virus during vaginal sex.
 YY  

= ome people
ave severe symp oms, suc
as
many painful sores, w
ile o
ers
ave mild
symp oms.
= An ini ial ou break of geni al
erpes usually
brings abou symp oms wi
in wo weeks of

aving sexual con ac wi
an infec ed person
and can las from wo o
ree weeks.
= T
e early symp oms can include:
= an i c
ing or burning feeling in
e geni al or
anal area
= flulike symp oms, including fever
= swollen glands
= pain in
e legs, bu ocks, or geni al area
= vaginal disc
arge
= a feeling of pressure in
e area below
e
s omac

= 
er la er symp oms of geni al
erpes may
include:
= small red bumps on
e penis, vagina, or
w
erever
e infec ion began. T
ese bumps may
become blis ers or painful open sores
a can
ake up o four weeks o
eal.
= i c
ing or burning in
e geni al area
= pain in
e legs, bu ocks, or geni al area
= vaginal disc
arge
= feeling pressure or discomfor around your
s omac

= fever
=
eadac
e
= muscle ac
es
= pain w
en urina ing
= swollen glands in
e geni al area

 
= T
ere is no rea men
a can cure geni al

erpes;
e virus will always be in your body.

er ain drugs suc
as  
,    
,
and  
 
 can s
or en ou breaks and
make
em less severe, or s op
em from

appening.
= 
en used along wi
safe sex prac ices,
@   
 can also
elp preven you from
passing
e infec ion o someone else.
= During ou breaks,
ese s eps can speed
ealing
and preven spreading of
e infec ion o o
er
si es of
e body or o o
er people.
= eep
e infec ed area clean and dry.
= Try no o ouc

e sores.
= as

ands af er con ac .
= Avoid sexual con ac from
e ime
e
symp oms are firs no iced un il
e sores
ave

ealed.
 

 
 

 



= No. nce you
ave
e virus, i s ays in your
body and
ere is a c
ance
a you will
ave
ou breaks. Medicine can s
or en and s op
ou breaks from
appening.
 


 

 

  
 




= f
e mo
er is
aving
er firs ou break w
ile
s
e is pregnan , s
e is more likely o pass
e
virus o
er baby.
= f
e ou break is no
e firs one,
e baby's
risk of ge ing
e virus is very low. Babies born
wi

erpes may be prema ure or may die, or

ey may
ave brain damage, severe ras
es, or
eye problems.
= Doc ors may do a
sec ion o deliver a baby if

e mo
er
as
erpes lesions near
e bir

canal o
elp preven passing
e virus. Also,
 
 can
elp babies born wi

erpes if

ey are rea ed rig
away.
= is no ye known if all geni al
erpes drugs are
safe for pregnan women o ake.
= ome doc ors may recommend  
 be
aken ei
er as a pill or
roug
an V during
pregnancy.
 

  
= ° 


= 
° 

= 
 

= Follow doc or's orders and finis
all
e
medicine
a you are given. Even if
e
symp oms go away.
= Avoid
aving any sexual ac ivi y w
ile you are
being rea ed for geni al
erpes and w
ile you

ave any symp oms of an ou break.
= Be sure o ell your sexual par ners, so
ey can
be es ed.
= Remember
a geni al
erpes is a life long
disease. Even
oug
you may
ave long periods
wi
no symp oms, you can s ill pass
e virus o
ano
er person.
  
 
  

= u erus womb) is a pears
aped organ, ucked

away in your pelvis. A normal u erus is abou
7.5cm long, 5cm wide and 2.5cm deep. nside, i
is
ollow wi

ick muscular walls. T
e lower
par of
e u erus dips down in o
e vagina and
is called
e cervix. T
e upper por ion is called

e fundus and
is is w
ere
e fer ilised egg
grows in o a baby.
= A small number of women
as a u erus womb)

a differs in s
ape or s ruc ure from
e norm.
T
is is called an abnormali y of
e u erus, or a
u erine abnormali y. Be ween one woman in 100
and one woman in 30
as a u erine abnormali y
Na
raync
and Toffle 1997).
= 's also difficul o know
ow many women
ave
an abnormali y, because i 's possible o
ave one
wi
ou knowing i .
 
 
 &
  
 &


  

= u erine abnormali ies do no affec a woman¶s
abili y o become pregnan and give bir
.
However, depending on
e abnormali y, i may
make i more difficul o carry a baby for
e full
nine mon
s of pregnancy.
= T
is may mean woman needs ex ra moni oring.
is possible o
ave a baby if you
ave one of

e following u erine abnormali ies:
= °


 
)*#" *!*
T
is is an ex remely rare +,! *#
abnormali y w
ere
e
u erus
as wo inner
cavi ies. Eac
cavi y may
lead o i s own cervix and
vagina. T
is means
ere
are wo cervixes and wo
vaginas.
= unicornua e u erus is
alf

e size of a normal u erus
"

 


and
ere is only one
fallopian ube.
= Because of i s s
ape, i is
described as a u erus wi

one
orn. is a very rare
abnormali y. develops in

e earlies s ages of life
= f you
ave a unicornua e
u erus, you probably
ave
wo ovaries. nly one will be
connec ed o your u erus
= ns ead of
e womb being
pears
aped,
is ype of
u erus is looks more like a +
 



ear , wi
a deep
inden a ion a
e op.
= is called a u erus wi
wo

orns, because of i s s
ape.
's
oug

a abou 20%
of women wi
u erine
abnormali ies
ave a
bicornua e u erus in
2004).
= T
is is w
ere
e inside of

e u erus is divided by a
muscular or fibrous wall,
#
 


called
e sep um.
= T
e sep um may ex end only
par way in o
e u erus
par ial sep a e u erus) or i
may reac
as far as
e
cervix comple e sep a e
u erus).
= ar ial sep a es, affec ing abou
33% of women wi

abnormali ies, are more common

an comple e sep a es.
= °
°

T
is looks more like a
normal u erus, excep i

as a dip, or slig

inden a ion a
e op.
  
Y
Y


= elvic exam
= Hys erpsalp
ingogram
= TZ
= MR
= aparoscopy
= Hys eroscpy
 Y

 Y
= Depends on
e ex en of
e abnormali y.
= For example, if p
ave a sep a e u erus,
unfor una ely, i may mean p . is a grea er risk
of
aving a miscarriage in 2004).
= f p
ave a sep a e u erus, s
e can
ave
rea men o correc
e abnormali y before
conceiving. f u erus differs only slig
ly from

e norm, p . no more likely
an anyone else o

ave a miscarriage.
= T
ere may be a grea er c
ance of p s.
aving
complica ions during pregnancy. Again, i
depends on w
a ype of abnormali y p .
as.
= f p .
as a unicorna e u erus, s
e is more likely
o
ave complica ions during pregnancy or bir

in 2004).
= Baby may no se le in o
e usual
eaddown
posi ion if your u erus is an unusual s
ape.
= He may ge in o a bo omdown, breec

posi ion, or a crossways, ranverse posi ion. T
is
may
appen if p .
ave a bicornua e u erus. a
caesarean sec ion is done because
is is
oug

o be
e safes way for
e baby o be born
Baker 2006).
= f p .
ave a unicornua e or bicornua e u erus, i
is perfec ly possible o
ave a successful
pregnancy. However, p ¶s. wa ers may break
early and may go in o prema ure labour R
G
2004).T
is is because
ere comes a poin w
ere

ere simply isn' enoug
room for your baby o
grow any more. vers re c
ing of your u erus
riggers labour.
= Ano
er reason you may
ave your baby early is
o do wi
your cervix, or
e neck of your
u erus. may no be s rong enoug
o keep your
baby inside, leading i o open oo early.
= T
is is called a weak cervix. ends o be a
problem for women wi
an abnormally s
aped
u erus w
o are expec ing
eir firs baby. T
e
more pregnancies you
ave,
e less of a
problem i is.
   
= RG
A MANAGEMENT: Mer oplas yis
used o res
ape
e u erus.
= However surgery is no indica ed in every case
and canno be performed on an unicornua e
u erus as
ere is no way o surgically enlarge a
u erus
=
ERV
A
ER
AGE maybe performed in
some cases o preven
e cervix from dila ing
prema urely and o increase fe al survival ra e.
= f p . knows
a s
e
as an abnormally s
aped
u erus, s
e may feel very anxious during
pregnancy. T
is may especially be
e case if p .

ave
ad previous miscarriages. 's bes o go o
all clinic appoin men s, because midwife and
obs e rician will wan o keep a close eye on you.
= Try o s ay as relaxed as possible and keep busy
o dis rac yourself. f you need someone o alk
o, con ac an organisa ion suc
as
e Na ional


ildbir
Trus .
= Ask
eal
care provider o explain clearly o
e
signs of prema ure labour. T
en if baby s ar s
coming oo soon, you will know w
a is

appening and can ge o
ospi al quickly.