Textbook of Gynocology for Nurses

1. Anatomy and Physiology of Female Reproductive Organs.................................................. 1
External Genitalia 1
Internal Genital Organs 3
Menstruation 13
Pelvic Floor 15
Anatomy of Other Organs Related to Gynecology 18
2. Examination of a Gynecological Patient................................................................................. 30
History Taking 30
Examination of Patient 32
General and Systemic Examination 32
Gynecological Examination 33
Other Diagnostic Tests 37
Liquid-based Cytology 43
Imaging Technologies in Gynecology 49
Culdocentesis 55
Breast Examination 61
Laser in Gynecology 64
3. Development of Genital Organs and Gonads....................................................................... 66
Development of External Genital Organs 66
Development of Internal Genital Organs 67
4. Congenital Malformations of Female Genital Organs ........................................................ 74
Textbook of Gynecology for Nurses xiv
Management 96
Treatment 96
Overall Management of Menopause and Abnormal Menopause 100
Nursing Management of the Women with Menopause
and Abnormal Menopause 102
6. Disorders of Menstrual Cycles ............................................................................................... 104
Dysmenorrhea (Menstrual Cramps, Painful Menstruation) 104
Mittelschmerz Syndrome 109
Pelvic Congestion Syndrome 110
Premenstrual Syndrome 111
Amenorrhea 115
Nursing Management of a Patient with Menstrual Disorders 125
7. Abnormal Uterine Bleeding.................................................................................................... 129
Menorrhagia 129
Polymenorrhea (Frequent Periods) 134
Hypomenorrhea 136
Oligomenorrhea 137
Metrorrhagia 137
Dysfunctional Uterine Bleeding 138
Changes in the Uterus in Dysfunctional Uterine Bleeding 142
Changes in the Ovary in Dysfunctional Uterine Bleeding 143
Postmenopausal Bleeding 150
8. Displacement of the Uterus..................................................................................................... 154
Position of the Uterus 154
Retroverted Uterus 154
Uterine Inversion 158
Acute Inversion of Uterus 159
Chronic Inversion of Uterus 162
Nursing Management of Patient with Displacement of Uterus 163
9. Pelvic Organ Prolapse .............................................................................................................. 165
Risk Factor 165
Types 166
Nursing Management of the Client with Pelvic Organ Prolapse 183
10. Genital Fistulae ......................................................................................................................... 186
Genitourinary Fistula 186
Vesicovaginal Fistula 186
Urethrovaginal Fistula 195
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Contents xv
Ureterovaginal Fistula 196
Rectovaginal Fistula 197
Lifestyle and Home Remedies 202
Nursing Management 203
11. Pelvic Inflammatory Diseases................................................................................................. 205
Incidence 205
Causative Organisms 205
Causes 206
Mode of Infection 206
Pathophysiology 206
Risk Factors 206
Clinical Features 207
Diagnosis 208
Laboratory Investigations 208
Prognosis 209
Complications 209
Prevention 209
Treatment 209
Patient Education to Prevent Reinfection 211
Chronic Pelvic Infection (Chronic PID) 211
Genital Tuberculosis 212
Tuberculosis of the Pelvis 214
Tuberculosis of the Fallopian Tubes 214
Tuberculosis of the Uterus 215
Tuberculosis of the Ovaries 216
Tuberculosis of the Cervix 216
Tuberculosis of Vulva and Vagina 217
Tuberculous Peritonitis 217
12. Infections of Pelvic Organs ..................................................................................................... 225
Endometritis 225
Salpingitis 228
Oophoritis 232
Cervicitis 234
Pelvic Abscess 238
Parametritis 239
Vulvitis 240
Vaginitis 242
Bartholinitis 246
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Textbook of Gynecology for Nurses xvi
Treatment 248
Nursing Process 250
13. Sexually Transmitted Infections ............................................................................................ 253
Epidemiology 253
Consequences of Sexually Transmitted Infections 253
Sexually Transmitted Infections and its Outcome in Pregnancy 254
Common Sexually Transmitted Infections 254
Nursing Process 292
14. Infertility..................................................................................................................................... 297
Classification 297
Prevalence 298
Causes 298
Unexplained Infertility 305
Diagnosis of Infertility 306
Diagnosis in Male 306
Laboratory Investigations for Male 306
Diagnosis in Female 309
Laboratory Examinations for Female 309
Treatment of Infertility 313
Treatment of Male Infertility 314
Treatment in Female Infertility 315
Ovulatory Dysfunction 316
Treatment for Tubal Damage 321
Treatment for Endometriosis 322
Treatment of Uterine Problems 323
Treatment of Cervical Mucus Hostility 323
Treatment for Immunological Infertility 324
Immunotherapy 324
Treatment for Unexplained Infertility 325
Assisted Reproductive Technology 326
Artificial Insemination 326
Methods of Surgical Sperm Retrieval 329
In Vitro Fertilization and Embryo Transfer 330
Gamete Intrafallopian Transfer 335
Zygote Intrafallopian Transfer 336
Intracytoplasmic Sperm Injection 336
Embryo or Oocyte Donation 337
Surrogacy and Adoption 339
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Contents xvii
15. Benign Lesions of Genital Tract............................................................................................. 342
Benign Vulvar Lesions 342
Non-neoplastic Epithelial Disorders 342
Inflammatory Diseases 342
Pigmentary Changes 345
Vulvar Ulcers 346
Benign Lesions of the Cervix 352
Benign Lesions of the Uterus 354
Benign Lesions of the Ovary 362
16. Endometriosis and Adenomyosis .......................................................................................... 373
Endometriosis 373
Adenomyosis 385
17. Genital Malignancy .................................................................................................................. 389
Vulval Carcinoma 389
Bartholin’s Gland Carcinoma 394
Vaginal Carcinoma 394
Cervical Cancer 397
Endometrial Carcinoma 401
Choriocarcinoma 404
Malignant Cancer 405
Ovarian Cancer 406
Fallopian Tube Carcinoma 410
Nursing Management of Genital Malignancy 413
18. Breast Disorders ........................................................................................................................ 414
Development of Breast 414
Anatomy of Breast 414
Anatomical Defects of the Breast 415
Mastalgia (Breast Pain) 416
Breast Lump 418
Galactorrhea 419
Drugs That Raise Prolactin 419
Benign Tumors in Breast 421
Breast Cancer 422
Nursing Process 427
Exercises After Breast Surgery 428
19. Genital Tract Injuries ............................................................................................................... 437
Genital Injuries 437
Old Complete Perineal Tear 437
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Textbook of Gynecology for Nurses xviii
Coital Injuries 440
Rape Victims 440
Direct Trauma 441
Foreign Bodies 441
Instrumental Injuries 442
20. Urinary Problems in Gynecology .......................................................................................... 443
Urinary Incontinence 443
Types 445
Stress Incontinence 445
Urge Incontinence 449
Functional Incontinence 452
Overflow Incontinence 452
Stress and Urge Incontinence 453
Transient Incontinence 453
Nursing Process of a Patient with Urinary Incontinence 453
Voiding Disorders 453
Urinary Tract Infection 457
Frequent or Urgent Urination 460
Dysuria 461
Nursing Process (Patient with Lower UTI) 464
Urethral Caruncle 466
21. Intersex........................................................................................................................................ 469
Nomenclature 469
Classification 469
Examinations and Tests 479
Treatment 480
22. Contraception............................................................................................................................. 482
Benefits of Contraception 482
Methods of Contraception 482
Temporary Methods 482
Parenteral Steroidal Contraceptives 502
Permanent Methods 509
Emergency Contraception 515
23. Radiotherapy, Chemotherapy, Immunotherapy and
Gene Therapy in Gynecology................................................................................................. 518
Radiotherapy 518
Chemotherapy 528
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Contents xix
Immunotherapy 540
Genes 542
24. Hormonal Therapy in Gynecology........................................................................................ 545
Estrogens 545
Antiestrogens 547
Progesterone 548
Antiprogesterone 549
Androgens (Testosterone/Antigonadotropins) 551
Antiandrogen 553
Gonadotropin-releasing Hormone 555
25. Gynecological Problems from Birth to Adolescence ......................................................... 559
Anatomy 559
Physiology 559
Gynecological Problems 559
Neonates, Toddlers and Infants 559
Premenarchal Disorders 561
Postmenarchal to Adolescence 566
26. Special Topics ............................................................................................................................ 570
Abnormal Vaginal Discharge 570
Pelvic Pain 574
Psychosexual Problems 578
27. Operative Gynecology ............................................................................................................. 591
Preoperative Management 591
Day Care Surgery 594
Intraoperative Care 594
Postoperative Management 597
After Surgery: Discomforts and Complications 601
Gynecological Operations 602
Major Surgical Operations 607
Operations of the Ovary 614
Index .................................................................................................................................................... 621