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Are there abnormalities on pelvic examination? A tubo-ovarian mass on pelvic examination should suggest salpingo-oophoritis, endometriosis with a chocolate cyst, or ectopic pregnancy. Perhaps the uterus is ... DIAGNOSTIC WORKUP
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Is there persistent or recurring abdominal or pelvic pain? The presence of pain with menorrhagia should make one suspect PID, endometriosis, and ectopic pregnancy.
Are there abnormalities on the ... DIAGNOSTIC WORKUP
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Are there abnormalities found on the vaginal examination? An enlarged uterus suggests pregnancy, fibroids, retained secundina, hydatiform mole, choriocarcinoma, endometrial carcinoma, or endometrial polyp ... DIAGNOSTIC WORKUP
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... Most cases of urethral discharge in both males and females are due to gonorrhea or
Chlamydia trachomatis
. When the smear and culture are negative for gonorrhea, a course of tetracycline can be given as a therapeutic trial to diagnose
Chlamydia
infection. Alternatively, the
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Is it purulent? A purulent vaginal discharge suggests nonspecific bacterial vaginitis and gonorrhea.
Is it frothy and yellow? This type of discharge is very often due to trichomoniasis vaginitis.
Is it ... DIAGNOSTIC WORKUP
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Is it tender? A tender vulval or vaginal mass would suggest vulvitis, hematoma, acute bartholinitis, or urethral caruncle.
Is it reducible? A reducible vulval or vaginal mass would suggest pudendal hernia, ... DIAGNOSTIC WORKUP
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... Ask the Following Question:
Is the lesion or are surrounding lymph nodes tender? The presence of tenderness of the lesion or the surrounding lymph nodes would suggest chancroid, lymphogranuloma venereum, herpes genitalis, and carcinoma. On the other hand, ... DIAGNOSTIC WORKUP
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Dysmenorrhea, or painful menstruation, is one of the most common gynecologic complaints. It is divided into two broad categories: Primary dysmenorrhea refers to severe uterine cramping during ovulatory menses and in the absence of demonstrable pelvic disease; secondary dysmenorrhea... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Vaginal discharge is a common complaint that is often accompanied by concerns about the presence of a sexually transmitted disease. Candida may present with extremely intense, often unbearable itch. Whenever one sexually transmitted disease is identified, a search... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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The pubertal vaginal flora is primarily lactobacillus, and the vagina has an acidic pH with a thick, estrogenized epithelium acting as a protective mechanism. The prepubertal vagina is less estrogenized and has a thinner epithelium, predisposing it to irritation. Any complaint of a... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Age of the patient is important when considering the differential diagnosis of abnormal vaginal bleeding. Pregnancy should always be ruled out despite a negative history of sexual activity. Bleeding that occurs before pubertal development of normal menarche... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... Visualizing the parts of the female reproductive system (see figure below), one can systematically formulate a differential diagnosis of this common malady.
DYSMENORRHEA
At the cervix,
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... A significant purulent urethral discharge invariably signals the diagnosis of gonorrhea and, until a Gram stain is done, little consideration is given to the other causes of a nonbloody urethral discharge. However, one should also consider other etiologic agents (
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... Again, the female genital tract can be infected by all sizes of organisms, thus a useful method for recalling the causes of a purulent vaginal discharge is to work from the smallest to the largest organism. Thus, we begin with herpes progenitalis and proceed to gonorrhea and nonspecific
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... As with most hemorrhages from body orifices, vaginal bleeding is best approached by the anatomic method. Thus, the important structures of the female genital tract are cross-indexed with etiologic categories as in Table 59 . In all bleeding symptoms, one must
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... Dysmenorrhea — painful menstruation — affects more than 50% of menstruating women; in fact, it's the leading cause of lost time from school and work among women of childbearing age. Dysmenorrhea may involve sharp, intermittent pain or dull,... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Abnormally heavy or long menstrual bleeding, menorrhagia may occur as a single episode or a chronic sign. In menorrhagia, bleeding is heavier than the patient’s normal menstrual flow; menstrual blood loss is 80 ml or more per monthly period. A form of dysfunctional uterine... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
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... Metrorrhagia — uterine bleeding that occurs irregularly between menstrual periods — is usually light, although it can range from staining to hemorrhage. Usually, this common sign reflects slight physiologic bleeding from the endometrium during ovulation.... History and physical examination ... Medical causes ... Other causes ... Special considerations
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... This excretion from the urinary meatus may be purulent, mucoid, or thin; sanguineous or clear; and scant or profuse. It usually develops suddenly, most commonly in men with a prostate infection.
History and physical examination
Ask the patient when he... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Common in women of childbearing age, physiologic vaginal discharge is mucoid, clear or white, nonbloody, and odorless. Produced by the cervical mucosa and, to a lesser degree, by the vulvar glands, this discharge may occasionally be scant or profuse due... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Postmenopausal vaginal bleeding — bleeding that occurs 6 or more months after menopause — is an important indicator of gynecologic cancer. But it can also result from infection, a local pelvic disorder, estrogenic stimulation, atrophy of the... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Geriatric pointers
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... Dysmenorrhea — painful menstruation — is the most common gynecologic complaint and a leading cause of absenteeism from school (affecting 10% of high school girls each month) and work (causing about 140 million lost work hours annually).... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Vaginal cancer accounts for approximately 2% of all gynecologic cancers. It usually appears as squamous cell cancer, but occasionally as melanoma, sarcoma, or adenocarcinoma.
Causes and incidence
The exact cause of vaginal cancer remains... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Dysmenorrhea—painful menstruation—affects more than 50% of menstruating women; in fact, it’s the leading cause of lost time from school and work among women of childbearing age. Dysmenorrhea may involve sharp, intermittent pain or dull, aching pain.... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Abnormally heavy or long menstrual bleeding, menorrhagia may occur as a single episode or a chronic sign. In menorrhagia, bleeding is heavier than the patient’s normal menstrual flow; menstrual blood loss is 80 ml or more per monthly period. A form of dysfunctional uterine bleeding,... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
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... Metrorrhagia—uterine bleeding that occurs irregularly between menstrual periods—is usually light, although it can range from staining to hemorrhage. Usually, this common sign reflects slight physiologic bleeding from the endometrium during ovulation. However, metrorrhagia may... History and physical examination ... Medical causes ... Other causes ... Special considerations
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... Urethral discharge from the urinary meatus may be purulent, mucoid, or thin; sanguineous or clear; and scant or profuse. It usually develops suddenly, most commonly in men with a prostate infection.
History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Common in women of childbearing age, a physiologic vaginal discharge is mucoid, clear or white, nonbloody, and odorless. Produced by the cervical mucosa and, to a lesser degree, by the vulvar glands, this discharge may occasionally be scant or profuse because of estrogenic stimulation... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Postmenopausal vaginal bleeding—bleeding that occurs 6 or more months after menopause—is an important indicator of gynecologic cancer. But it can also result from infection, a local pelvic disorder, estrogenic stimulation, atrophy of the... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Geriatric pointers ... Patient counseling
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... Albert A. Meyer
Approach Dysmenorrhea can be defined as a complaint of pain experienced during or immediately before menstruation. Up to 90% of women experience this symptom for some part in their lives (1). Risk factors... History (2) ... Physical examination ... Laboratory testing (3) ... Diagnostic assessment (1)
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... Albert A. Meyer
Approach Menorrhagia, defined as excessive bleeding from the uterus, is a common gynecologic complaint. Each year, 200,000 American women undergo hysterectomy for the treatment of menorrhagia. Approximately 20% of women... History (2) ... Physical examination ... Testing ... Diagnostic assessment (3)
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... George P.N. Samraj
Discharge from the urethra is a common symptom. The characteristics and the cause of urethral discharge (UD) vary widely. Discharge can be profuse or scanty; clear, yellowish, or white; mucopurulent or serous; bloody, watery, or frank pus. UD can... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Albert A. Meyer
Vaginal symptoms, especially discharge, are responsible for 10% of all physician visits by women. Each year, approximately 12 million women in the United States are treated for vaginitis (1).
Approach An... History (2) ... Physical examination (4) ... Testing (5) ... Diagnostic assessment
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... Differential Overview
❑ Physiologic discharge
❑ Candida vulvovaginitis
❑ Bacterial vaginosis
❑ Trichomonas vaginitis ... Diagnostic Approach ... Clinical Findings
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... Differential Overview
❑ Ovulatory bleeding
❑ Anovulatory bleeding
❑ Uterine leiomyoma
❑ Dysfunctional bleeding
&... Diagnostic Approach ... Clinical Findings
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... Urethral discharge from the urinary meatus may be purulent, mucoid, or thin; sanguineous or clear; and scant or profuse. It usually develops suddenly, most commonly in men with a prostate infection.
History
Ask... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Common in women of childbearing age, physiologic vaginal discharge is mucoid, clear or white, nonbloody, and odorless. Produced by the cervical mucosa and, to a lesser degree, by the vulvar glands, this discharge may occasionally be scant or profuse due to estrogenic stimulation... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Postmenopausal vaginal bleeding — bleeding that occurs 6 or more months after menopause — is an important indicator of gynecologic cancer, but it can also result from infection, a local pelvic disorder, estrogenic stimulation, atrophy of the endometrium, and physiologic... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Geriatric pointers ... Patient counseling ... Pictures
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...Vaginal discharge is abnormal except forphysiologic leukorrhea, which occurs during the first few weeksof life and with the onset of puberty. Principal Causes of Vaginal Discharge Prepubertalonset Physiologicleukorrhea Vulvovaginitis ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Vaginalbleeding is physiologic in the neonatal period and during the normalmenstrual cycle. Maternal estrogen stimulates endometrial growthin the fetus, but after delivery, the decrease in serum estrogenleads to endometrial sloughing and mild vaginal bleeding, whichmay last for... Principal Causes of Vaginal Bleeding ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Dysmenorrhea—painful menstruation—affects more than 50% of menstruating women; in fact, it's the leading cause of lost time from school and work among women of childbearing age. Dysmenorrhea may involve sharp, intermittent pain or dull, aching pain. It's usually... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Abnormally heavy or long menstrual bleeding, menorrhagia may occur as a single episode or a chronic sign. In menorrhagia, bleeding is heavier than the patient's normal menstrual flow; menstrual blood loss is 80 ml or more per monthly period. A form of... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Metrorrhagia—uterine bleeding that occurs irregularly between menses—is usually light, although it can range from staining to hemorrhage. Usually, this common sign reflects slight physiologic bleeding from the endometrium during ovulation... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Urethral discharge is an excretion from the urinary meatus that may be purulent, mucoid, or thin; sanguineous or clear; and scant or profuse. It usually develops suddenly, most commonly in men with a prostate infection.
History and ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Common in women of childbearing age, physiologic vaginal discharge is mucoid, clear or white, nonbloody, and odorless. Produced by the cervical mucosa and, to a lesser degree, by the vulvar glands, this discharge may occasionally be scant or profuse due to estrogenic... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Postmenopausal vaginal bleeding—bleeding that occurs 6 or more months after menopause—is an important, albeit not a definitive, indicator of gynecologic cancer. It can also result from infection, a local pelvic disorder, estrogenic stimulation, atrophy... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
...
Visualizing the parts of the female reproductive system (see figure),
one can systematically formulate a differential diagnosis of this common
malady. At the cervix, stenosis, cervical polyps, and other neoplasms
may obstruct the egress of blood and induce... Pictures
... READ EXCERPTS »
...
A significant purulent urethral discharge invariably signals the
diagnosis of gonorrhea and, until a Gram stain is done, little consideration
is given to the other causes of a nonbloody urethral discharge. However, one
should also consider other... Pictures
... READ EXCERPTS »
...
Again, the female genital tract can be infected by all sizes of
organisms, thus a useful method for recalling the causes of a purulent
vaginal discharge is to work from the smallest to the largest organism.
Thus, we begin with herpes progenitalis and proceed to... Pictures
... READ EXCERPTS »
...
As with most hemorrhages from body orifices, vaginal bleeding is best
approached by the anatomic method. Thus, the important structures
of the female genital tract are cross-indexed with etiologic categories as
in Table 59. In all bleeding... Pictures
... READ EXCERPTS »
The first step in effective treatment for vulvovaginal candidiasis is correct diagnosis to rule out bacterial vaginitis and establish species of...
Appropriate treatment for vulvovaginal candidiasis depends on a variety of factors including severity of symptoms, species of yeast and patient...
Stress takes its toll by making us anxious, depressed and not able to function as fully as we'd like. What many don't know is that stress can...
Sleep is necessary to feel refreshed, but now we know sleep actually impacts the way the body functions. Sleeping poorly can affect how often you get...