WMSU

MANAGEMENT OF PATIENT WITH FEMALE

REPRODUCTIVE INFLAMMATORY DISORDER

JOBEL A. NUVAL, RN, MAN 1

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 Physical Assessment
• Physical assessment of the female reproductive system usually is
conducted as part of a scheduled screening (e.g., for an annual Pap
smear) or for a specific reproductive health problem.
• The female reproductive system is assessed by inspection and
palpation.
• Ask the woman to void before having the examination. Prior to the
examination, collect all necessary equipment and explain the
techniques to the woman to decrease anxiety.
• Put on disposable gloves before beginning the examination and wear
them throughout the examination.
• Ask the woman to remove her clothing and put on a gown. Ensure
that the examining room is private and warm. 3
 Vaginal and Cervical Assessment

• This assessment is primarily conducted by a physician or an

advanced practice nurse.
• Use a vaginal speculum to inspect the vaginal walls and cervix.
The vaginal opening varies, depending on age, sexual history,
and vaginal births.
• Vaginal mucosa is normally pink and moist, without discharge
or odor.
• There should be no bulging or loss of urine.
• The cervix is normally smooth and pink, without lesions and has
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 VAGINAL
SPECULUM

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 ABNORMAL FINDINGS:
• Bluish color of the cervix and vaginal
mucosa may be a sign of pregnancy-
Chadwick’s Sign
• A cervix to the right or left of the
midline may indicate a pelvic mass,
uterine adhesions, or pregnancy.
• Projection of the cervix more than 3
cm into the vaginal canal may
indicate a pelvic or uterine mass.
• Transverse or star-shaped cervical
lacerations reflect trauma causing
tearing of the cervix. 6
• An enlarged cervix is associated
with infection.
• Nabothian cysts (small, white, or
yellow raised, round areas on
the cervix) are signs of infection.
• Cervical polyps may be cervical
or endometrial in origin.

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 PREMENSTRUAL
SYNDROME
 COMBINATION OF SYMPTOMS
THAT OCCURS BEFORE THE
MENSTRUAL PERIOD.
 CAUSE IS UNKNOWN, MOST
PROB. SEROTONIN REGULATION.
Fluctuations of serotonin, a brain
chemical (neurotransmitter)
that's thought to play a crucial
role in mood states, could trigger
PMS symptoms.
 Insufficient amounts of serotonin
may contribute to premenstrual
depression, as well as to fatigue,
food cravings and sleep
problems.
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 TREATMENT:
3. Reduce stress
1. Modify your diet
Eat smaller, more-frequent meals to
• Get plenty of sleep.
reduce bloating and the sensation of • Practice progressive muscle relaxation or
fullness.
Limit salt and salty foods to reduce deep-breathing exercises to help reduce
bloating and fluid retention.
headaches, anxiety or trouble sleeping
Choose foods high in complex
carbohydrates, such as fruits, vegetables (insomnia).
and whole grains.
2. Incorporate exercise into your regular • Try yoga or massage to relax and relieve
routine stress.
Engage in at least 30 minutes of brisk
walking, cycling, swimming or other • Vitamin supplements. Calcium,
aerobic activity most days of the week.
Regular daily exercise can help improve magnesium, vitamin E and vitamin B-6
your overall health and alleviate certain
symptoms, such as fatigue and a
have all been reported to soothe
depressed STATE. symptoms
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 DYSMENORRHEA

medical term for painful

menstrual periods which are
caused by uterine
contractions.
Primary dysmenorrhea refers
to recurrent pain, while
secondary dysmenorrhea
results from reproductive
system disorders.
Excessive production of
prostaglandins, which causes
painful contraction of the
uterus and arteriolar 10
 Medical Treatment:
• Symptoms may include:
• Pain relievers. Over-the-counter pain
• Cramping in the lower
abdomen relievers, such as ibuprofen (Advil,
•
Motrin,mefenamic Acid-POnstel
Pain in the lower abdomen
others) or naproxen sodium (Aleve),
• Low back pain
at regular doses starting the day
• Pain radiating down the legs
before you expect your period to
• Nausea begin can help control the pain of
• Vomiting cramps.
• Diarrhea
• Fatigue
• Weakness
• Fainting
• Headaches
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LOW LEVEL LOCAL HEAT
THERAPHY

Heat – Vasodilator
Increased blood flow/ circulation
Counteract constriction and muscle
constriction

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WMSU Bananas, wheat germ, sunflower seeds, oats,
parsley, salmon, dark chocolate, pineapple
seeds, ginger, fenugreek seeds, spinach and
green tea
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 CERVICITIS

WMSU

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 Cervicitis

• Cervicitis is inflammation of the cervix -- the lower end of

the uterus that opens into the vagina.
• Cervicitis is very common.
• It may be caused by a number of factors, including
infections, chemical or physical irritations, and allergies.

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 Causes of Cervicitis:
• Acute cervicitis is usually caused by an infection.
• Chronic cervicitis is more likely from a noninfectious cause.
• Infections can result from the introduction of
staphylococcus or streptococcus bacteria into the
uterus.
• The sexually transmitted diseases chlamydia and gonorrhea
are also significant causes of cervicitis. It has been
estimated as much as 40 percent of cases of cervicitis are
related to chlamydia. Herpes simplex virus, trichomonas and
mycoplasma genitalium are also sometimes a cause. 17
• Noninfectious causes of cervicitis include exposure to
chemicals or mechanical irritation. These include:
• Chemical irritation from spermicides or douches or the
latex used in condoms
• Reaction to diaphragms, cervical caps, tampons or
pessaries inserted.
• Radiation therapy or systemic inflammatory diseases

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 Symptoms of Cervicitis:
• Many women with cervicitis don't have any symptoms. The
condition may be discovered only after a routine exam or
test.
• Signs and symptoms, if present, may include:
• Grayish or pale yellow vaginal discharge
• Abnormal vaginal bleeding, such as bleeding after sex or
between periods
• Pain during sex
• Difficult, painful, or frequent urination
• Pelvic or abdominal pain or fever, in rare cases 19
 DIAGNOSTIC EXAM:
• Pap smear-a test used to
detect abnormal cells on
the cervix that are
cancerous or may
become cancerous. The
cervix is the lower part of
the uterus that connects
to the vagina.
• A Pap smear is conducted
by taking a sample of
cells from the surface of
the cervix during a pelvic
exam using a swab or
small brush. 20
 • The best time to schedule your Pap test is at least 5 days
after the end of your menstrual period.
How often you need a Pap smear is determined by various
factors,
including your age and risk.

Age Pap smear frequency

<21 years old, none needed
21-29 every 3 years

every 3 years or an HPV test every 5 years or a

30-65 Pap test and HPV test together every 5 years

you may no longer need Pap smear tests; talk

65 and older to your doctor to determine your needs 21
22
City Health Office( Reproductive Health
Wellness Clinic)

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 Pap Smear Preparation:
• You shouldn’t have a Pap smear during your period. Heavy
bleeding can affect the accuracy of the test.
• For the most accurate Pap smear, doctors recommend taking
the following steps, starting 48 hours before your test:
• Don’t have sex or use lubricants.
• Don’t use sprays or powders near the vagina.
• Don’t insert anything into the vagina, including tampons,
medications, creams, and suppositories.
• Don’t rinse the vagina with water, vinegar, or other fluid
(douche). 24
 RESULTS:
• Normal result- negative result is a good thing. That means your
doctor didn’t find any precancerous or cancerous cells on your
cervix.
• Abnormal result- If your results come back positive, it doesn’t
mean you have cancer.
• There are several reasons you could have an abnormal Pap smear.
• Mild inflammation or minor cell changes (dysplasia)
• HPV or other infection
• Cancer or pre-cancer
• Lab test error
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 Preventing Cervicitis
• You can decrease your risk of getting cervicitis by taking the following
steps:

• Have your partner always use condoms during sex.

• Limit the number of people you have sex with.
• Don't have sex with a partner who has genital sores or penile discharge.
• If you get treatment for a sexually transmitted disease, ask your doctor if
your partner should also be treated.
• Don't use feminine hygiene products. These may cause irritation of your
vagina and cervix.
• If you have diabetes, try to maintain good control of your blood sugar.
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TREATMENT:

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 PELVIC
INFLAMMATORY
DISEASE(PID)

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• is an inflammatory condition of the pelvic cavity that may
begin with cervicitis and involve the uterus
• (endometritis), fallopian tubes (salpingitis), ovaries
(oophoritis), pelvic peritoneum, or pelvic vascular system.
Infection, which may be acute, subacute, recurrent, or
chronic and localized or widespread, is usually caused by
bacteria but may be attributed to a virus, fungus, or
parasite.

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 Pathophysiology
• The exact pathogenesis of • Under various conditions, the
PID has not been organisms may proceed to one or
determined, but it is both
presumed • fallopian tubes and ovaries and into
the pelvis. In bacterial infections
• that organisms usually enter that
the body through the • occur after childbirth or abortion,
vagina, pass through the pathogens are disseminated directly
• cervical canal, colonize the • through the tissues that support the
endocervix, and move uterus by way of the lymphatics and
upward into the uterus. • blood vessels

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• Pelvic infection is most often sexually transmitted but can
also occur with invasive procedures such as endometrial
biopsy, abortion, hysteroscopy, or insertion of an
intrauterine device. Bacterial vaginosis (a vaginal
infection) may predispose women to pelvic infection. Risk
factors include early age at first intercourse, multiple
sexual partners, frequent intercourse, intercourse without
condoms, sex with a partner with an STI, and a history of
STIs or previous pelvic infection.

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Clinical Manifestations

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 If diagnosed and treated early, the
complications of PID can be prevented. Some
of the complications of PID are:
• Formation of scar tissue both outside and inside the
fallopian tubes that can lead to tubal blockage;
• Ectopic pregnancy (pregnancy outside the womb);
• Infertility (inability to get pregnant);
• Long-term pelvic/abdominal pain.

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 Medical Management

• Broad-spectrum antibiotic therapy is prescribed, usually a

combination of:
• Ceftriaxone (Rocephin),
• Doxycycline and
• Metronidazole (Flagyl).

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Usual Adult Dose for Pelvic Inflammatory
Disease

• Ceftriaxone (Rocephin)
• 1 to 2 g IV or IM once a day (or in equally divided doses
twice a day)
• Duration of therapy: 4 to 14 days
• Complicated infections: Longer therapy may be required.

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 DOXYCYCLINE

• Oral doxycycline 100 mg twice daily for 14 days, along

with a second- or third-generation cephalosporin
administered parenterally.

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 SALPINGITIS

WMSU

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• Salpingitis is an infectious • Other possible pathogens include
disease that has been Gardnerella vaginalis (see image),
Escherichia coli, Haemophilus
associated with multiple
influenzae, group B beta-hemolytic
organisms.
streptococci, and bacteroides.
• Neisseria gonorrhea and
• In the wake of widespread
Chlamydia trachomatis are the
screening programs for gonorrhea
most commonly identified and chlamydia infections, it
pathogens in both PID and became clear that other pathogens
salpingitis. are becoming more common as
the cause of salpingitis in the
developed world.

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 Pathophysiology
• Salpingitis occurs when Symptoms of Salpingitis:
Pelvic pain, especially during ovulation
pathogens move through the and menstruation
cervix, endometrium, and, Abdominal pain
Bloating
eventually the fallopian tubes. Changes in the color or smell of vaginal
• Intrauterine devices, discharge
endometrial biopsy, dilation and Lower back pain
Fever
curettage, hormonal changes Nausea or vomiting
brought on by menstruation, Painful sexual intercourse
and retrograde menstruation all
predispose patients to Tetracyclines alone or in combination with
penicillin G or ampicillins are at present
salpingitis. the most frequently used antibiotics -
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 Complications
• If left untreated, patients with salpingitis may develop
chronic pelvic pain, which can be difficult to treat. This
chronic pain may be caused by pelvic adhesions or the
formation of tubo-ovarian abscesses.
• Additionally, hydrosalpinx can cause pelvic pain.

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41
 OOPHORITIS
inflammation, and
enlargement in one or
both ovaries.
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• typically caused by a bacterial • Oophoritis is usually the result of sexually
transmitted infections (STIs) like
infection, and may result from chlamydia and gonorrhea. You can reduce
chronic pelvic inflammatory your risk by practicing safe sex with all
partners.
disease (PID).
• This form differs from • Bacteria can also get into the reproductive
autoimmune oophoritis, a tract through your cervix. This can
happen:
disorder caused by a
malfunction of the immune • if an intrauterine device (IUD) is inserted
system. incorrectly
• during an abortion
• after a miscarriage
• during childbirth
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 CLINICAL MANIFESTATIONS:
The goals of pharmacotherapy are to reduce
• pain in the lower abdomen and pelvis morbidity, prevent complications and eradicate
• menstrual bleeding that’s heavier the infection:
Gentamicin (Garamycin) -- Aminoglycoside
than usual antibiotic for gram-negative coverage. Used in
• bleeding between menstrual cycles combination with both an agent against gram-
positive organisms and one that covers
• pain or bleeding during intercourse anaerobes. Gentamicin and clindamycin are
• heavy vaginal discharge, which may second-line agents for inpatient treatment of
oophoritis.
have a foul odor Clindamycin (Cleocin) -- Inhibits bacterial
• burning sensations or pain during growth, possibly by blocking dissociation of
peptidyl t-RNA from ribosomes causing RNA-
urination dependent protein synthesis to arrest. Used in
• difficulty urinating conjunction with gentamicin as second-line
treatment for oophoritis.
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• Pregnancy and fertility • Surgical Care:
• If treated early, infectious • Oophoritis may be managed
oophoritis can be treated before with surgery when medical
it has an effect on your fertility. If treatment has shown no effect
treatment is delayed, your after 48-72 hours.
fertility may be compromised by • Surgical options may include
scar tissue and blockages.
laparoscopy with drainage of
These can sometimes be
the abscess
removed surgically, allowing
you to conceive. • removal of adnexa
• and total abdominal
hysterectomy-bilateral sagittal
oophorectomy (TAH/BSO).
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46
 SEXUALLY TRANSMITTED
DISEASES

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 CANDIDIASIS
• FUNGAL OR YEAST INFECTION • Women who are more likely to get vaginal
• CANDIDA ALBICANS- candidiasis include those who:
CAUSATIVE AGENT
• Are pregnant
• Use hormonal contraceptives (for example,
birth control pills)
• Have diabetes
• Have a weakened immune system (for
example, due to HIV infection or medicines
that weaken the immune system, such as
steroids and chemotherapy)
• Are taking or have recently taken antibiotics

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• Symptoms: • Medical Management:
• Vaginal discharge( cottage • Antifungal Agents:
cheese-like appearance), Miconazole( Monistat),
watery, thick Nystatin( Mycostatin),
• Vaginal itching Clotrimazole, Terconazole
• Pain during sexual intercourse Cream
• Pain or discomfort when • Inserted at the vaginawith an
urinating applicator at BEDTIME
• 1, 3, 7 night treatment courses
• Oral Meds: Fluconazole

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 BACTERIAL VAGINOSIS
• OVERGROWTH OF
ANAEROBIC BACTERIA AND
GARDNERELLA VAGINALIS
NORMALLY FOUND IN THE
VAGINA AND ABSENCE OF
LACTOBACILLI.
• FISH-LIKE ODOR
• GRAY TO YELLOWISH
VAGINAL DISCHARGE
• USUALLY ASSOCIATED
WITH RECURRENT UTI,
DOUCHING, INCREASED
SEXUAL ACTIVITY, HYGIENE

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 Medical
Management
• Metronidazole( Flagyl)- PO 2x a
day for 1 week treatment.
• Clindamycin vaginal cream
• Both partner

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 TRICHOMONIASIS

• Aka “Trich” The parasite passes from an infected person to an uninfected

• is a very common person during sex.
In women, the most commonly infected part of the body is the
sexually
lower genital tract (vulva, vagina, cervix, or urethra). In men, the
transmitted disease most commonly infected body part is the inside of the penis
(STD). (urethra).
• It is caused by Symptoms:
infection with a
Frothy,thin, yellow- green discharge,malodorous
protozoan parasite
Burning,itching, multiple small petechiae ( strawberryspots)
called Trichomonas
vaginalis.
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WMSU

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 Nucleic acid amplification testing
(NAAT)
• is considered the gold standard for detecting a
trichomoniasis infection and can be used in people of all
genders.
• This test can identify the genetic material of the parasite,
called DNA or RNA, in a sample of urine or a swab of
fluid from the vagina or cervix.

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• Medical Management:
• Metronidazole- most
effective, both partners
Strongly abstain from alcohol.

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 CHLAMYDIA
pain or burning while peeing.
pain during sex. (dyspareunia)
• is a common STD that can infect lower belly pain.
both men and women. abnormal vaginal discharge (may be yellowish
and have a strong smell)
• It can cause serious, permanent bleeding between periods.
damage to a woman's reproductive pus or a watery/milky discharge from the penis.
system. swollen or tender testicles.
pain, discharge and/or bleeding around the
• This can make it difficult or anus.
impossible for her to get pregnant
later on.
• Chlamydia can also cause a
potentially fatal ectopic pregnancy
(pregnancy that occurs outside the
womb) 56
 Transmission:
• It can be spread by vaginal, oral, or
anal sex without a condom or
latex/polyurethane barrier.
• Pregnant people can pass it on to
their babies during delivery.

Treatment:
• doxycycline – taken every day for a
week.
• azithromycin – one dose of 1g,
followed by 500mg once a day for 2
days. 57
GONORRHEA-CLAP/TULO

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• You can get gonorrhea by
having vaginal, anal, or oral
sex with someone who has
gonorrhea.
• A pregnant person with
gonorrhea can give the
infection to their baby during
childbirth.

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 SYMPTOMS
:
• Men: Men who contract • Women: In women, symptoms of
gonorrhoea may experience gonorrhea can include:
symptoms like:
• An unusual thick discharge from the
• An unusual white, yellow or green vagina, which may be green or
discharge from the tip of the penis yellow in color
• Pain or a burning sensation • Pain during passing urine
during passing urine • Pain or tenderness in the lower
• Inflammation (swelling) of the abdominal area (this is less
foreskin and testticles common)
• Pain or tenderness in the testicles • Bleeding between periods or
or prostate gland (though is rare) heavier periods (this is less
common) 61
 Diagnosis
• Gonorrhea is diagnosed with gram
stain or with culture of the bacteria,
however newer polymerase chain
reaction (PCR) based testing
methods are becoming more
common.
• Azithromycin (Zithromax) 1 gram
given orally in a single dose, plus
ceftriaxone (Rocephin) 250 mg given
intramuscularly as first-line therapy.
• If ceftriaxone is not available at the
time of treatment, cefixime may be
used as an alternative.
• However, N gonorrhoeae has
developed increased resistance to
cefixime. For this reason, cefixime
should be used only when 62
1. The nurse is counseling a mother who wants her teenage
daughter to have a Pap smear and pelvic examination.
Which statement by the nurse is most accurate?
A. “If your daughter is over 18, she needs a pelvic
examination and Pap smear.”
B.“A teenager does not need this examination unless she is
sexually active.”
C.“Teach her to have her first examination by the age of 21 at
the latest.”
D. “It is not needed unless you are worried about sexually
transmitted diseases.” 63
Answer: C.

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2. When scheduling an annual pelvic examination and Pap
test, the client asks if she should abstain from intercourse
before the test. Which is the nurse’s best response?
A. “Yes. Avoid having intercourse for 24 hours before the
test.”
B “Yes. Avoid having intercourse for 2 hours before the
test.”
C “No. Intercourse does not interfere with this test.”
D “No. Intercourse can actually enhance the test results.”

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ANSWER:A

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• Which one of the following is a factor associated with the
development of bacterial vaginosis?
A. Recent use of diaphragm and spermicide
B. Frequent douching
C. Regular use of latex condoms when having sex
with men
D. Recent antibiotic course with penicillin or
amoxicillin

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ANSWER: B.
• Bacterial vaginosis is associated with a multitude of factors related to sexual activities,
vaginal hygiene practices, and the presence of other sexually transmitted infections. The
following are the major factors identified among women that increase their risk of
developing bacterial vaginosis.

• Multiple sex partners

• New sex partners
• Douching (due to disruption of normal vaginal microflora)
• Lack of condom use during sex
• Uncircumcised male sex partner
• Use of copper-containing intrauterine device
• Active menses
• Seropositivity for herpes simplex virus-2 (HSV-2) in the woman
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• A 22 yr old woman with multiple sexual partners seeks care after
several weeks of experiencing painful and frequent urination and
vaginal discharge. Although the results of a culture of cervical
secretions are not yet available, the nurse explains to the patient
that she will be treated as if she has gonorrhea and chlamydia in
order to prevent which of the following?
A. obstruction of the fallopian tubes
b. endocarditis and aortic aneurysms
c. disseminated gonococcal infection
d. Complicated STD infection

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ANSWER: A -obstruction of the
fallopian tubes

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