Female Reproductive System

Several problems common among older females will be discussed here. These include vaginitis, and
cervical and breast cancer.
1. Vaginitis
Normal aging changes in the female reproductive system (see Chapter 6) make elderly women
more at risk for infection. The vaginal canal becomes more fragile with age due to atrophy. Less
vaginal lubrication and more alkaline pH due to lower estrogen levels put elderly women at
increased risk of vaginitis. Symptoms of vaginitis may be similar to UTI or yeast infection, and
may include itching and foul-smelling discharge. Vaginitis is treated with topical estrogen
creams or estrogen replacement therapy. Women should be instructed to avoid douching and
feminine deodorant sprays or perfumes. Wearing cotton undergarments may also help. A watersoluble lubricant such as K-Y gel should be used during intercourse if vaginal dryness is a
problem, because the use of other lubricants such as Vaseline contributes to cases of vaginitis.
2. Cervical Cancer
Cervical cancer incidence peaks in women age 50 to 60, with women over age 65 accounting
for a significant number of new cases and deaths each year. Healthy People 2000 initiatives
have helped to raise awareness among health care providers and the general public about the
need for screening for cervical cancer. However, even with heightened awareness, studies
indicate that older patients are generally treated less aggressively (radiation versus surgery) and
have poorer outcomes than younger patients, with some older women refusing treatment
altogether (Rissner & Murphy, 2005). Additionally, late- stage cancer diagnoses and subsequent
death are more common among women over 65 than among those in younger age groups
(Bradley, Given, & Roberts, 2004). The current American Cancer Society guidelines state that
women should have annual Pap smears until age 30. After age 30, with no history of abnormal
smears, women may elect to have the screening done every 23 years. Those age 70 and older
may choose to stop screening entirely if they have had no abnormal results in the past three
smears and no abnormal results within 10 years time prior to age 70 (Smith, Cokkinides, &
Eyre, 2003). Risk factors include smoking, onset of sexual intercourse prior to age 18, and
multiple sexual partners. Screening offers the opportunity of early treatment. A new vaccine is
being researched using the human papillomavirus to prevent cervical cancer. The symptoms of
cervical cancer are not usually evident in early stages, but may include vaginal bleeding,
generally without pain until later stages. Prognosis is good if detected early. Most early
precancerous lesions can be successfully treated with laser or cryotherapy. Traditional treatment
for cancer generally includes radiation and/or surgery, depending on the stage of progression.
3. Breast Cancer
Breast cancer is the second leading cause of death for women. This disease claims more than
40,000 lives per year and affects over 200,000 people annually in the United States (American
Cancer Society, 2005b). The incidence of breast cancer in women over age 50 has increased in
recent years. Half of all breast cancers are diagnosed in women over the age of 65 (National
Breast Cancer Foundation, 2005). Men may also develop breast cancer, though this is much less
frequent, and they should not be excluded from education about the disease. Screening
guidelines for older women include mammography, yearly clinical breast exam (CBE), and
monthly self breast exam (SBE). As of age 40, women should have mammography yearly until
age 75, and then every 23 years thereafter. There are several risk factors for breast cancer,
some controllable, some not. These include family history, late menopause, having the first
child after age 30, high fat intake, and alcohol consumption. Of course, primary nursing care
focuses on those factors that can be modified. Geriatric nurses should be particularly aware of
the importance of early detection among those older women who are at higher risk. Signs and
symptoms of breast cancer include a breast mass or lump, breast asymmetry, dimpling of the

skin or orange peel appearance, and nipple changes (Kennedy-Malone, Fletcher, & Plank,
2000). Mammography and biopsy in addition to lab tests, chest x-ray, and bone scans are
indicated for diagnosis (Case Study 11-5). There are various stages of breast cancer. Stage I has
a 98% survival rate at 5 years, whereas Stage IV has a 16% survival rate at 5 years (National
Breast Cancer Foundation, 2005). Treatment for breast cancer depends on stage, but includes
any combination of radiation, chemotherapy, and/or surgery. Depending on the type of tumor,
hormone therapy may also be effective. Nursing care is important at all levels of prevention.
Nurses working with older adults should encourage appropriate screening according to
recommended guidelines. The elderly should be taught proper technique for self breast exam
and encouraged to have regular checkups with their physician. Although controversy exists over
the use of mammography, it remains an effective means to detect many cancerous tumors at an
earlier stage with minimal risk to the person. For older women undergoing mastectomy as
treatment for breast cancer, nurses may expect a longer time to be needed for recovery.
Promotion of the return of full range of motion of the arm on the operative side is essential.
This may require physical therapy in addition to the psychosocial and emotional support
involved in rehabilitation.