Reported by: Jelly M.

Danda
 Female reproductive system disorders have many
physiologic as well as psychosocial implications.
Any condition that affects the female
reproductive system can negatively influence a
woman’s self-perception and overall sense of
well-being. In many cultures, females hesitate to
seek for medical treatment for such conditions.
 Moreover, female reproductive system disorders
may necessitate treatments like invasive
procedures that may be perceived as
embarrassing by many clients. Surgical
procedures may also alter reproductive
functions.
 1. Pelvic Inflammatory Disease (PID)
 An infectious process that may involve the
fallopian tubes, ovaries, pelvic peritoneum,
veins or uterine connective tissue.
 Causes: Transmission of infection through sexual
intercourse.
 Immunologic or renal disorders
 Childbirth or abortion
 Frequent vaginal douching
 Multiple sex partners
 Sexual contact with a partner with urethritis or
gonorrhea.
 Signs and symptoms:
 Abdominal and pelvic pain
 Low back pain
 Dyspareunia (painful sexual intercourse)
 Menstrual irregularity
 Causative Agents
 Chlamydia Trachomatis
 Clostridium Perfringes
 Neisseria Gonorrheae

 Collaborative management for PID:

 Antibiotic Therapy
 Relief of pain
 Bed rest (semi-Fowlers to localize infection within
the pelvic area)
 Increase fluids
 NGT (if ileus is present)
 Removal of IUD if present
 Surgery: Hysterectomy with BSO (Bilateral Salpingo-
oophorectomy)
 Laparotomy with incision and drainage of abscesses
and lysis of adhesions
 Patient Education
 a. Avoid using tampons, having intercourse, or
douching for at least 1 week after antibiotic
therapy.
 Explain methods to prevent VD’s (if caused by
STD’s).
 Encourage patient’s sex partner to be
examined and treated.
 Describe symptoms of recurrence to be
reported to the physician.
 Handwashing, good perianal care.
 Use perineal pads, change frequently
according to amount of vaginal drainage.
 Acute pain related to inflammation.
 Risk for impaired skin integrity related to
drainage of purulent secretion on perineum.
 Risk for deficient fluid volume related to
fever.
 Deficient knowledge regarding condition.
 Dysfunctional Uterine Bleeding (DUB)
 Occurs during the reproductive years and is
associated with neuroendocrine factors:
 A. Unovulatory, painless
 B. Premenopausal age 40-50 years.
 C. Menometrorrhagia (excessive bleeding during
menstruation and in between menstruations ).
 Abnormal Uterine Bleeding (AUB)
can occur at anytime and is associated with non-
menstrual cycle factors including tumors,
inflammation, trauma, pregnancy, or exogenous
hormones effects.
 a.Hypomenorrhea.Abnormal small amount
of menstrual flow
 b.Menorrhagia (hypermenorrhea). Increased
amount or duration of menstrual bleeding.
 c. Metrorrhagia. Any pathologic uterine
discharge.
 Oligomenorrhea. Infrequent menstruation
 Polymenorrhea.Increased frequency of
menstruation.
 Postmenopausal bleeding. Bleeding from the
reproductive tract occurring 1 year or more
after menopause.
 Spotting.small amount of bloody vaginal
discharge ranging from pink to dark brown.
 Anovulation or threatened abortion
 Chronic PID
 Endometrial polyps
 Intrauterine Device (IUD)
 Oral contraceptive use
 Uterine Cervical Cancer
 Endometrial Hyperplasia
 Lacerations
 Systemic Disease (Leukemia, Blood
Dyscrasias)
 Abortion is the leading cause of vaginal
bleeding in women of childbearing age. This
occurs before fetal viability (before 20
weeks).
 Abortions are classified as threatened,
inevitable, incomplete, missed, septic,
habitual and therapeutic.
 Collaborative management for clients with
uterine bleeding:
 Surgery
 Dilatation and Curettage (D and C)
 Hysterectomy (vaginal, abdominal)
 Total Abdominal hysterectomy with Bilateral
Salpingo-oophorectomy (TAH/BSO).Removal of
the uterus, ovaries, and fallopian tubes
through abdominal incision.
 Medications
 Oral contraceptive therapy
 Progesterone or progestogen (Provera)
 Estrogen (Premarin)
 Prostaglandin inhibitors (Meclofenamate Na)
 Leuprolide acetate (Lupron)
 Analgesic
 Monitor amount of blood loss-recording of
 dates,types of flow, number of pads or
tampons used (weigh pads or tampons).
 Monitor VS for signs of shock.
 IV fluid therapy, blood transfusion as needed.
 Iron rich foods, iron supplement
 Psychosocial support.
 Nursing Diagnosis
 Fatigue due to blood loss.
 Pain related to uterine cramps.
 Sexual dysfunction related to altered body
function associated with uterine bleeding.
 Ismenstruation that is painful enough to
limit normal activity or cause a woman to
seek medical treatment.
 Increased sensitivity of myometrium and
endometrium to prostaglandin F2 can
produce uterine contractions and ischemia,
causing cramping pain.
 Signs and symptoms:
 Colicky pain in lower pelvis and radiates to
perineum, vulva, rectum, back of thighs.
 Nausea and vomiting
 Diarrhea
 Urinary frequency
 Abdominal bloating
 Breast tenderness
 Collaborative management for clients with
dysmenorrhea:
 Medications:
 NSAID’s (Ibuprofen, Naproxen) as prescribed
 Oral Contraceptives (relieve pain by suppressing
ovulation) as prescribed
 Adequate exercise
 Balanced diet (include complex carbohydrates,
fruits and vegetables)
 Decrease consumption of salt, alcohol, sugar,
caffeine.
 Adequate rest and sleep
 Avoid tobacco
 Attention to personal hygiene
 Nursing Diagnosis
 Pain related to uterine cramps
 Disturbed body image related to negative
feeling about menses.
 Endometriosis

 Is an abnormal growth of endometrial

tissues outside the uterine cavity.
 It has a familial pattern.
 Common among women with ages 25 to
35 years.
 Greatest incidence in women who tend
to marry later and have fewer children.
 Occurs in young women with congenital
obstruction of the vagina or cervix that
are associated with reflux menstruation.
 Potential complications: infertility,
pregnancy wastage, decreased
fertilization, pain , decrease pregnancy
rate, ascites.
 Signs and symptoms
 Pain
 Pelvic pain with menstruation .
 Vague aching, cramping or bearing down
sensation in pelvis or lower back.
 Dyspareunia.
 Pain with defecation.
Bimanual pelvic exam, reveals tender nodules
among uterosacral ligaments; uterus may be
immobile.
 Bleeding: menses excessive, long, or both.
 Behavioral changes: personality changes,
depression.
 Collaborative management for clients with
endometriosis:
 Medication
 Gn-RH agonists (e.g. Nafarelin acetate nasal
spray; Leuprolide acetate (lupron);
Progestins (e.g. Medroxyprogesterone
(Provera); Oral contraceptives.
 Danazol (Danocrine). Produces anovulation
and amenorrhea. It is a testosterone
derivative.
 Surgery: Laparoscopy, TAH-BSO,resection or
cautery destruction of visible lesions.
 Psychosocial support.
 Leiomyomas (Myomas)
 Well-circumscribed, nonencapsulated, benign
tumors of the uterine musculature; also called
myomas, fibromyomas, fibromas, or fibroids.
 Signs and symptoms:
 Pain
 Dull ache, soreness or colicky pain
 Dysmenorrhea
 Pelvic heaviness
 Feeling of bearing down
 Backache
 Dyspareunia
 Elimination problems
 Constipation
 Urinary frequency and urgency
 Nocturia
 Incontinence
 Abdominal problems
 Irregular nodules in the lower abdomen
 Irregular abdominal contour
 Swelling
 Bleeding
 Profuse bleeding with flooding or clots
 Menses excessive, long or both
 Temperature
 Elevated with degenerating tumor
 Anemia caused by gradual blood loss over time
 Collabortaive management for clients with
leiomyomas:
 Surgery
 Hysteroscopic/laparoscopic myomectomy
 Total hysterectomy
 Medication
 Gn-RH agonist
 Lupron
 Analgesics
 Pelvic examination at regular intervals
 Nursing Diagnosis
 Pain related to pressure of tumor on adjacent
structures.
 Disturbed body image related to biophysical
changes.
 Polyps
 Benign neoplasms or protruding growths in the
cervix or endometrium.
 Occur with leiomyomas and endometrial
hyperplasia.
 Collaborative management for clients with
polyps:
 Surgery
 D and C
 Hysteroscopic resection of polyps
 Cryosurgery for cervical polyps.
 Uterine Prolapse
 An abnormal protrusion of the uterus through
the pelvic floor and vaginal outlet.
 Also called pelvic relaxation, pudendal hernia.
 Most common cause: childbirth trauma like
episiotomy extension, laceration of the vagina
or cervix, improper episiotomy repair.
 Other precipitating factors associated with
softening or relaxation of uterine support
structures.
 Pregnancy
 Menopause
 Chronic abdominal pressure( ex. Obesity)

 Signs and symptoms:

o sense of heaviness or dragging in the low
back or pelvis, a feeding of something falling
out, bilateral groin pain, sacral backache.
o Vagina: dyspareunia, excess vaginal mucus,
spotting and bleeding in the postmenopausal
period.
o Cervix: constant irritation with tissue
changes and cervical erosions.
o Bowel: hemorrhoids from straining with
constipation.
o Urinary: urinary frequency or urgency, UTI,
stress incontinence.
o Behavioral changes: disturbed body image.

 Potential Complications:
o Difficulty with ambulation resulting from
externally exposed portion of the uterus,
bladder or rectum.
 Excess purulent discharge
 Bleeding
 Decubitus ulcer
8. Procidentia- inverted vagina due to
prolapsed uterus.
 Collaborative management
o Hormones: topical estrogen, premarin
vaginal cream 2 times/week for 6 weeks,
then once a week.
 Pessaries: devices wom in the vagina to
support the uterusfor women who ar poor
surgical risks.
 Perineal exercises (Kegel’s exercise) to
improve pelvic tone.
 Surgery
 Retropubic cystourethropexy (to maintain
urinary continence)
 Vaginal Hysterectomy
 Anterior and posterior colporrhaphy
 Colpocleisis (Le Fort’s Operation ) for elderly,
or high risk patients who are not sexually
active.
 Psychosocial support
 Nursing Diagnosis
 Deficient knowledge related to lack of
information
 Disturbed body image related to biophysical
changes.
 Pain related to pressure of protruding uterus
 Hormonal Disorders
 Premenstrual Syndrome (PMS)
 The cyclic recurrence, during the luteal
phase of the menstrual cycle, of a
combination of physical, psychologic, and
behavioral changes sufficient to interfere
with normal activities.
 Increase in incidence and severity as
women near menopause.
 Symptoms generally appear 7 to 10 days
before menses and decrease with onset of
menses.
 Edema. Progesterone stimulates the
production of aldosterone which increases
sodium retention and edema formation.
 Emotionality. The decrease in brain level of
monoamine oxidase that occurs as estrogen
production falls before menses probably
account for the feeling of depression.
 Fluctuation of monoamine oxidase and
catecholamine levels in the brain may result to
irritability.
 Decreased serotonin is also associated with
depression in humans.
 Headache. Associated with vertigo and
migraine.
 Other manifestations:
 Breast tenderness and enlargement
 Abdominal bloating
 Food craving
 Compulsive eating
 Forgetfulness
 Increase libido
 Acne
 Collaborative management for clients with
PMS:
Medications
Hydrochlorothiazide
Mefenamic acid
Naproxen
Medroxyprogesterone
Alprazolam (Xanax)
Leuprolide (Lupron)
Antidepressants (Elavil, Doxepine)
Vitamin B and E
Limit intake of salt, refined sugar, caffeine, animal
fats.
Relief of pain.
Adequate rest and sleep. Fatigue intensifies
symptoms.
 Psychosocial support. Reassure symptoms are
temporary.
 Nursing Diagnosis
 Anxiety related to cyclical changes in health
status.
 Ineffective coping related to inability to
conserve adaptive energies.
 Menopause and Climacteric
 Menopause is the physiological cessation of
menses.
 Climacteric is the transitional period during
which reproductive function diminishes and
eventually ceases.
 Menopause occurs between the ages of 48 and
55 average is 50 years.
 Menopause occurs as a result of progressive
decline in ovarian secretion of estrogen.
 Signs and symptoms
 Subjective data
 Hot flushes
 Night sweats
 Diaphoresis
 Vertigo
 Syncope
 Numbness/ tingling/ pain in joints
 Insomia
 Chillysensation
 Headache
 Lack of appetite
 Genitals
 Decreased labial fat
 Labia majora flattens
 Labia minora disappers
 Vagina becomes smaller with shallow fornices
with dry appearance.
 Abdomen: abdominal fat deposition
 Cardiovascular.Tachycardia, palpitations
 Breast: reduction in size
 Body hair: loss of pubic and axillary hair,
increase in facial hair and lip hair.
 Behavioral changes: anxiety, decrease tolerance
level, body image changes.
 Potential Complications: osteoporosis, coronary
heart diseases.
 Collaborative management for clients with
dysmenorrhea:
 Medications
 Estrogen
 a.Premarin (for hot flushes, prevention of
osteoporosis)
 b. Transdermal estradiol (Estraderm)
 Estrogen cream applied to vagina for
vaginitis
 Progestins or progesterones
 a. Provera (to prevent endomentrial CA)
 Biophosphonates: Fosamax
 Psychosocial support group/ classes
 Nursing Diagnosis
 Deficient knowledge related to lack of
information about self-care manegement.
 Disturbed body image related to body
change.
 Ineffective sexuality patterns related to
knowledge deficit about alternative response
to health-related topics.