Chapter 54:Female Reproductive Problems
Infertility is the inability to achieve a pregnancy after at least 1 year of regular
intercourse without contraception.
Diagnostic studies include ovulatory studies, tubal patency studies, and postcoital studies.
Management depends on the cause and can include supplemental hormone therapy and
Abortion is the loss or termination of a pregnancy before the fetus has developed to a
state of viability.
Abortions are classified as spontaneous (those occurring naturally) or induced (those
occurring as a result of mechanical or medical intervention).
Nursing management includes the use of comfort measures to provide needed physical
and mental rest. The support of the patient and her family is essential.
Premenstrual syndrome (PMS) is a common disorder of physical and psychologic symptoms
during the last few days of the menstrual cycle and before onset of menstruation.
PMS is thought to have a biologic trigger with compounding psychosocial factors.
Physical symptoms include breast discomfort, abdominal bloating, sensation of weight gain,
episodes of binge eating, and headache. Anxiety, depression, irritability, and mood swings are
some of the emotional symptoms.
No single treatment is available to relieve symptoms. The goal is to reduce symptom severity.
Dysmenorrhea is abdominal cramping pain or discomfort associated with
o Primary dysmenorrhea is caused by an excess of prostaglandin F α (PGF α)
and/or an increased sensitivity to it.
o Secondary dysmenorrhea is acquired after adolescence; pelvic causes include
endometriosis, chronic pelvic inflammatory disease, and uterine fibroids.
Treatment for primary dysmenorrhea includes heat, exercise, and drug therapy. For
secondary dysmenorrhea, it depends on the cause. Abnormal vaginal or uterine bleeding is a common gynecologic concern and is caused by
dysfunction of hypothalamic-pituitary-ovarian axis, infection, and stressful changes in
lifestyle. Treatment varies depending on the cause but can include drug therapy and
An ectopic pregnancy is the implantation of the fertilized ovum anywhere outside the
Any blockage of the tube or reduction of tubal peristalsis that impedes or delays the
zygote passing to the uterine cavity can result in tubal implantation.
Risk factors include a history of pelvic inflammatory disease, prior ectopic pregnancy,
current progestin-releasing intrauterine device (IUD), progestin-only birth control failure,
and prior pelvic or tubal surgery.
Eventually the tube ruptures with acute peritoneal symptoms of abdominal/ pelvic pain,
missed menses, and irregular vaginal bleeding. Less acute symptoms begin 6 to 8 weeks
after last normal menstrual period.
Surgery is usually the treatment.
Menopause is the physiologic cessation of menses associated with declining ovarian
function. It is usually considered complete after 1 year of amenorrhea.
Ovarian changes start the cascade of events that result in menopause.
Premenopausal symptoms include hot flashes, irregular vaginal bleeding, fat
redistribution, and a tendency to gain weight.
Treatment might include hormone replacement, drug therapy, and alternative therapies.
INFECTION AND INFLAMMATION OF VAGINA, CERVIX, AND VULVA
Infection and inflammation of vagina, cervix, and vulva commonly occur when natural
defenses of the acid vaginal secret