NCLEX: Reproductive system disorders

Reproductive system disorders: STDs

As a type of Reproductive system disorders, STDs are the most common infections in the United States, and chlamydia infection is the most common STD. Morbidity and mortality depend on the type and stage of the disease. Many STDs are easy to treat when detected early.


What causes it
Transmission of the causative organism, which may include bacteria, viruses, protozoans, fungi, or ectoparasites, leads to infection.
Patients at high risk include those:

younger than age 25

with multiple sexual partners

with a history of STDs.

Four groups not to join

The incidence of STDs is higher among prostitutes, people having sexual contact with prostitutes, drug abusers, and prison inmates.

These contagious diseases are usually transmitted through intimate sexual contact with an infected person. Some are transmitted to an infant during pregnancy or childbirth.

What to look for
The chief signs of STDs are vaginitis, vaginal or penile discharge, epididymitis, lower abdominal pain, pharyngitis, proctitis, and skin or mucous membrane lesions.

The stealthy STD

Many STDs produce no symptoms, especially in women. By the time the STD is detected, the woman may have severe complications, such as PID, infertility, ectopic pregnancy, or chronic pelvic pain.

What tests tell you
The diagnosis of a specific STD is made by physical examination, patient history, and laboratory tests to determine the causative organism.

How it’s treated
Treatment is based on the specific causative organism. Treatment guidelines for each STD are available from the Centers for Disease Control and Prevention (CDC).

Recommended resources

The CDC recommends that these resources be available for patients with STDs:
• medical evaluation and treatment facilities for patients with human immunodeficiency virus infection
• hospitalization facilities for patients with complicated STDs, such as PID and disseminated gonococcal infection
• referrals for medical, pediatric, infectious disease, dermatologic, and gynecologic-obstetric services
• family-planning services
• substance abuse treatment programs.

What to do
• Ensure the patient’s privacy and confidentiality. Avoid judging the patient’s lifestyle and making assumptions about his sexual preference.
• Provide emotional support, and encourage the patient to discuss his feelings. He may be anxious and fearful and may experience altered self-esteem and self-image.
• Evaluate the patient. When assessing treatment outcome, note whether the patient remains asymptomatic without recurrent infections. Make sure the patient understands how to prevent spreading the infection.

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Reproductive system disorders: Testicular torsion

Testicular torsion is the abnormal twisting of the spermatic cord that results from rotation of a testis or the mesorchium (a fold in the area between the testis and epididymis). It causes strangulation and, if untreated, eventual infarction of the testis. This condition is almost always unilateral. Although it’s most common between ages 12 and 18, it may occur at any age. The prognosis is good with early detection and prompt treatment.

What causes it
Testicular torsion is caused in part by abnormalities inside or outside the tunica vaginalis, the serous membrane covering the internal scrotal cavity.

Twist and shout

Intravaginal torsion is caused by:
• abnormality of the tunica vaginalis and the position of the testis
• incomplete attachment of the testis and spermatic fascia to the scrotal wall, leaving the testis free to rotate around its vascular pedicle.

Extravaginal torsion is caused by:
• loose attachment of the tunica vaginalis to the scrotal lining, causing spermatic cord rotation above the testis
• sudden forceful contraction of the cremaster muscle due to physical exertion or irritation of the muscle.

In testicular torsion, the testis rotates on its vascular pedicle and twists the arteries and vein in the spermatic cord. This interrupts blood flow to the testis, resulting in vascular engorgement, ischemia, and scrotal swelling.

What to look for
Torsion produces excruciating pain in the affected testis or iliac fossa. Physical examination reveals tense, tender swelling in the scrotum or inguinal canal and hyperemia of the overlying skin. Scrotal swelling is unrelieved by rest or elevation of the scrotum.

What tests tell you
• Doppler ultrasonography helps distinguish testicular torsion from strangulated hernia, undescended testes, or epididymitis. How it’s treated If manual reduction is unsuccessful, torsion must be surgically corrected within 6 hours after the onset of symptoms to preserve testicular function (70% salvage rate). Treatment consists of immediate surgical repair by orchiopexy (fixation of a viable testis to the scrotum) or orchiectomy (excision of a nonviable testis). Without treatment, the testis becomes dysfunctional and necrotic after 12 hours.

What to do
• Before surgery, promote the patient’s comfort as much as possible.
After surgery, take these steps:
– Administer pain medication as ordered.
– Monitor voiding, and apply an ice bag with a cover to reduce edema.
– Protect the wound from contamination. Otherwise, allow the patient to perform as many normal daily activities as possible.
– Evaluate the patient for pain and postoperative complications.

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Reproductive system disorders: Uterine leiomyomas

Also known as myomas, fibromyomas, and fibroids, uterine leiomyomas are the most common benign tumors in women. They usually occur in the uterine corpus, although they may also appear on the cervix or on the round or broad ligament. These neoplasms are usually multiple and occur in about 20% of women over age 35. They’re three times more common in Blacks than in Whites. They become malignant (leiomyosarcoma) in only 0.1% of patients.

Where the leiomyomas are

Leiomyomas are classified three ways, according to location:

intramural (in the uterine wall)

submucosal (protruding into the endometrial cavity)

subserosal (protruding from the serosal surface of the uterus).

In all three cases, the uterine cavity may become larger, increasing the endometrial surface area and causing increased uterine bleeding.

What causes it
The cause of uterine leiomyomas is unknown, but steroid hormones, including estrogen and progesterone, and several growth factors, including epidermal growth factor, have been implicated as regulators of leiomyoma growth.

Excessive levels of estrogen and human growth hormone (hGH) probably contribute to uterine leiomyoma formation by stimulating susceptible fibromuscular elements. Large doses of estrogen and the later stages of pregnancy increase tumor size and hGH levels. Conversely, uterine leiomyomas usually shrink or disappear after menopause, when estrogen production decreases.

What to look for
Signs and symptoms of uterine leiomyomas include:
• submucosal hypermenorrhea (cardinal sign) and possibly other forms of abnormal endometrial bleeding, dysmenorrhea, and pain
• with large tumors, a feeling of heaviness in the abdomen, pain, intestinal obstruction, constipation, urinary frequency or urgency, and irregular uterine enlargement.

What tests tell you
• Blood studies showing anemia support the diagnosis.
• D&C or submucosal hysterosalpingography detects submucosal leiomyomas.
• Laparoscopy shows subserous leiomyomas on the uterine surface.

How it’s treated
Appropriate intervention depends on the severity of symptoms, the size and location of the tumors, and the patient’s age, parity, pregnancy status, desire to have children, and general health.
Treatment can include these measures:
• A surgeon may remove small leiomyomas that have caused problems in the past or that appear likely to threaten a future pregnancy. This is the treatment of choice for a young woman who wants to have children.
• Tumors that twist or grow large enough to cause intestinal obstruction require a hysterectomy, with preservation of the ovaries if possible.
• If a pregnant woman has a leiomyomatous uterus no larger than a 6-month normal uterus by the 16th week of pregnancy, surgery is usually unnecessary and the pregnancy outcome is favorable.
• If a pregnant woman has a leiomyomatous uterus the size of a 5-month to 6-month normal uterus by the 9th week of pregnancy, spontaneous abortion will probably occur, especially with a cervical leiomyoma. A hysterectomy may be performed 5 to 6 months after delivery (when involution is complete), with preservation of the ovaries if possible.

What to do
• If your patient develops severe anemia from excessive bleeding, administer iron and blood transfusions as ordered.
• Evaluate the patient for abnormal bleeding or pain and postoperative complications.

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